1487655882 NPI number — MARK A BISIGNANI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487655882 NPI number — MARK A BISIGNANI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BISIGNANI

Provider First Name:

MARK

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1487655882

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/28/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1165 S DORA ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

UKIAH

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95482-8325

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1165 S DORA ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

UKIAH

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95482-8325

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

707-463-3636

Provider Business Practice Location Address Fax Number:

707-463-2714

Provider Enumeration Date:

08/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  38599 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0001X , with the licence number: G151223 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 18A02BU . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2400131 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2400132 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 32628800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 112202 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 26712 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 108453 . This is a "CHOICE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 963071012227 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP19060 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 001219000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".