1629155163 NPI number — LAURA E LEPPINK NP

Table of content: LAURA E LEPPINK NP (NPI 1629155163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629155163 NPI number — LAURA E LEPPINK NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEPPINK
Provider First Name:
LAURA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAVRIL
Provider Other First Name:
LAURA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629155163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6201 N SHERIDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMORE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48829-9726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-881-5310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E WARWICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48801-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-463-1101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

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: 363LA2200X , with the licence number:  4704220033 , 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: 5008771120 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00665152 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1059826 . This is a "MCLAREN HEALTH PLAN-COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1059826 . This is a "MCLAREN HEALTH PLAN-MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N55170016 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1059826 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000018089 . This is a "PHP FAMILYCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000018089 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7399969 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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