1003902115 NPI number — MRS. COLLEEN BETH VERBEKE MA, LLP

Table of content: MRS. COLLEEN BETH VERBEKE MA, LLP (NPI 1003902115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003902115 NPI number — MRS. COLLEEN BETH VERBEKE MA, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERBEKE
Provider First Name:
COLLEEN
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003902115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28000 DEQUINDRE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48092-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-753-0405
Provider Business Mailing Address Fax Number:
586-753-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4777 E OUTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48234-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-369-5000
Provider Business Practice Location Address Fax Number:
313-369-5545
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301012106 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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