1508813825 NPI number — MICHAEL A FINAN MD

Table of content: MICHAEL A FINAN MD (NPI 1508813825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508813825 NPI number — MICHAEL A FINAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINAN
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508813825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 HIGHWAY 90
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAUTIER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39553-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-497-7576
Provider Business Mailing Address Fax Number:
228-497-8869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 DENNY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCAGOULA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39581-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-809-5251
Provider Business Practice Location Address Fax Number:
228-809-5255
Provider Enumeration Date:
05/30/2006

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: 207VX0201X , with the licence number:  26622 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 27428 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51533766 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051542862 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009932837 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00110922 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009911199 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009932838 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0700139 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51530156 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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