1285718759 NPI number — SHISHIR SENAPATI MD PC

Table of content: (NPI 1285718759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285718759 NPI number — SHISHIR SENAPATI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHISHIR SENAPATI MD PC
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:
1285718759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43211 DALCOMA DR
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-6309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-263-9355
Provider Business Mailing Address Fax Number:
586-263-6835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43211 DALCOMA DR
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-6309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-9355
Provider Business Practice Location Address Fax Number:
586-979-9810
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENAPATI
Authorized Official First Name:
SHISHIR
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
586-284-9444

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  55066528 , 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: 1105015402 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 867733 . This is a "CAPE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: NC011918 . This is a "MCARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: H33108 . This is a "HAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 135474 . This is a "GREAT LAKES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480005810 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7995388 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00283142 . This is a "MEDICARE TRAVELER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10158860001 . This is a "WELLNESS PLAN" identifier . This identifiers is of the category "OTHER".




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