1629168885 NPI number — PARTNERS IN FOOT HEALTH P.C.

Table of content: (NPI 1629168885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629168885 NPI number — PARTNERS IN FOOT HEALTH P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS IN FOOT HEALTH 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:
1629168885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3976 DIX HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48146-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-386-5750
Provider Business Mailing Address Fax Number:
313-386-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3976 DIX HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48146-3940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-386-5750
Provider Business Practice Location Address Fax Number:
313-386-0579
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLENECH
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
313-386-5750

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  CO001358 , 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: 4034087 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4858251900 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480009053 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480H219870 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 125159 . This is a "CARE CHOICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2733214 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480029417 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5656449 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000003439 . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 107182 . This is a "CARE CHOICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4858251630 . This is a "BCBSM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3313528 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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