1205176674 NPI number — MICHAEL R. LIEPMAN MD, PLLC

Table of content: (NPI 1205176674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205176674 NPI number — MICHAEL R. LIEPMAN MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL R. LIEPMAN MD, 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:
1205176674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10925 E FG AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49083-9627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-598-9487
Provider Business Mailing Address Fax Number:
269-665-6553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 STADIUM DRIVE
Provider Second Line Business Practice Location Address:
ELIZABETH UPJOHN COMMUNITY HEALING CENTER
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-343-1651
Provider Business Practice Location Address Fax Number:
269-382-7078
Provider Enumeration Date:
02/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LIEPMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ROGER
Authorized Official Title or Position:
PRINCIPAL OWNER
Authorized Official Telephone Number:
269-343-1651

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4301033951 , 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: 4184022 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com