1407895469 NPI number — ASSOCIATED OBSTETRICS & GYNECOLOGY, P.C.

Table of content: (NPI 1407895469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407895469 NPI number — ASSOCIATED OBSTETRICS & GYNECOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED OBSTETRICS & GYNECOLOGY, P.C.
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:
1407895469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 S TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-0286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-338-0100
Provider Business Mailing Address Fax Number:
248-977-3014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-0286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-338-0100
Provider Business Practice Location Address Fax Number:
248-977-3014
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKE
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACRICE MANAGER
Authorized Official Telephone Number:
248-338-0100

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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: 160F36364 . This is a "BCBS OF MICHIGAN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5101013679 . This is a "PATRICIA KONDRATENKO, DO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5101016558 . This is a "LISA HELMICK, DO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301063928 . This is a "PAUL CORSI, MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4704224123 . This is a "JULIE BILLIS FNP-BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301502068 . This is a "ASHLEE O'SHELL, MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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