1386759181 NPI number — DR. MICHELLE A ECHEVARRIA MD

Table of content: DR. MICHELLE A ECHEVARRIA MD (NPI 1386759181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386759181 NPI number — DR. MICHELLE A ECHEVARRIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECHEVARRIA
Provider First Name:
MICHELLE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1386759181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 LONDON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43040-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-644-6115
Provider Business Practice Location Address Fax Number:
937-619-4150
Provider Enumeration Date:
08/20/2006

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: 207P00000X , with the licence number:  3508042 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103432 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2523353 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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