1154385672 NPI number — RICHARD MARC TOOKER MD, MPH

Table of content: RICHARD MARC TOOKER MD, MPH (NPI 1154385672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154385672 NPI number — RICHARD MARC TOOKER MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOKER
Provider First Name:
RICHARD
Provider Middle Name:
MARC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1154385672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3255 122ND AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ALLEGAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49010-9511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-673-5411
Provider Business Mailing Address Fax Number:
269-673-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3255 122ND AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ALLEGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49010-9511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-673-5411
Provider Business Practice Location Address Fax Number:
269-673-4172
Provider Enumeration Date:
04/13/2006

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: 2083P0901X , with the licence number:  4301044487 , 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: 10926 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 118700 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 164490661 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6004860 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OP390039 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 386004860050 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 771860393 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 386004860052 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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