1033107867 NPI number — DONALD B PASSAL MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033107867 NPI number — DONALD B PASSAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASSAL
Provider First Name:
DONALD
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1033107867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 LAPEER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48607-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-759-6464
Provider Business Mailing Address Fax Number:
989-399-8233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1522 JANES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-755-0316
Provider Business Practice Location Address Fax Number:
989-755-0956
Provider Enumeration Date:
10/06/2005

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: 208000000X , with the licence number:  4301038058 , 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)

  • Identifier: P74211 . This is a "BLUE CARE NETWORK OF MICH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1033107867 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0983722 . This is a "HEALTHPLUS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1010623 . This is a "MCLAREN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160G36111 . This is a "BCBS OF MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2987397 . This is a "MOLINA HEALTH CARE OF MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104 . This is a "COMMUNITY CHOICE OF MICHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121653 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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