1124238654 NPI number — DR. ALICE FLORINA DOE M.D.

Table of content: DR. ALICE FLORINA DOE M.D. (NPI 1124238654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124238654 NPI number — DR. ALICE FLORINA DOE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOE
Provider First Name:
ALICE
Provider Middle Name:
FLORINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STROE
Provider Other First Name:
ALICE
Provider Other Middle Name:
FLORINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124238654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1535 GULL RD STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-1659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-345-1161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 SHAFFER ST STE 124
Provider Second Line Business Practice Location Address:
BORGESS HEALTH
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-226-5967
Provider Business Practice Location Address Fax Number:
269-552-0284
Provider Enumeration Date:
05/23/2007

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: 207R00000X , with the licence number:  4301083451 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 4301083451 , 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: 1124238654 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1407827900 . This is a "NPI NUMBER FOR THE GROUP PRACTICE (SLEEP DIAGNOSTICS OF MICHIGAN PC)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1124238654 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700F510150 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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