1114962644 NPI number — JEFFREY P. LETZER, DO, PLC. DBA KALAMAZOO HEMATOLOGY & ONCOLOGY

Table of content: (NPI 1114962644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114962644 NPI number — JEFFREY P. LETZER, DO, PLC. DBA KALAMAZOO HEMATOLOGY & ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY P. LETZER, DO, PLC. DBA KALAMAZOO HEMATOLOGY & ONCOLOGY
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:
KALAMAZOO HEMATOLOGY & ONCOLOGY
Provider Other Organization Name Type Code:
3
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:
1114962644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1634 GULL RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-341-9200
Provider Business Mailing Address Fax Number:
269-341-4197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1634 GULL RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-341-9200
Provider Business Practice Location Address Fax Number:
269-341-4197
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LETZER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
269-341-9200

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: JL010182 , 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: 01008954 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 053 . This is a "CARE SOURCE MEDICAID HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N89040 . This is a "MEDICARE PLUS BLUE MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110C912010 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4290016 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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