1679617419 NPI number — LINDA M DUBAY MD PLLC

Table of content: (NPI 1679617419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679617419 NPI number — LINDA M DUBAY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA M DUBAY MD PLLC
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:
1679617419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Mailing Address:
STE 504
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-662-4333
Provider Business Mailing Address Fax Number:
248-662-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
STE 504
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-662-4333
Provider Business Practice Location Address Fax Number:
248-662-3022
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUBAY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
248-662-4333

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  LD053074 , 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: 103881 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 312461 . This is a "PRORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1679617419 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020F369860 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0206368471 . This is a "BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0206368471 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F57526 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 020F369860 . This is a "BCN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 025832 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4361872 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 112457004 . This is a "UNITED HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DP1484 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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