1093899569 NPI number — BADDIGAM FAMILY PSYCHIATRIC ASSOCIATES PLLC

Table of content: (NPI 1093899569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093899569 NPI number — BADDIGAM FAMILY PSYCHIATRIC ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BADDIGAM FAMILY PSYCHIATRIC ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093899569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-7002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-263-6812
Provider Business Mailing Address Fax Number:
586-263-6835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43211 DALCOMA DR
Provider Second Line Business Practice Location Address:
STE. 3
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-6309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-6812
Provider Business Practice Location Address Fax Number:
586-263-6835
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BADDIGAM
Authorized Official First Name:
PRAMEELA
Authorized Official Middle Name:
DEVI
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
586-263-6812

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1082559 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB055388 . This is a "LIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: VM053562 . This is a "LIC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 260E021040 . This is a "BCBSM GRP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0459615 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1265467682 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2605017381 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 476905610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5840532 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: F63502 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 476904710 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 819269000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: BB053679 . This is a "LIC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1033313069 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138868 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2204444 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2605017531 . This is a "BCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 140176 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680E020960 . This is a "BCBSM PHD GRP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com