1164490926 NPI number — DR. SANDOR ROBERT TERNER DO

Table of content: DR. SANDOR ROBERT TERNER DO (NPI 1164490926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164490926 NPI number — DR. SANDOR ROBERT TERNER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERNER
Provider First Name:
SANDOR
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1164490926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4113 GOLF RIDGE DR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-364-4200
Provider Business Mailing Address Fax Number:
616-364-7347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28050 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
BOTSFORD GENERAL HOSPITAL ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-364-4200
Provider Business Practice Location Address Fax Number:
616-364-7347
Provider Enumeration Date:
03/09/2006

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: 207L00000X , with the licence number:  5101012682 , 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: 4487156 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109554200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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