1679794697 NPI number — VIORICA ELENA ALAWA D.O.

Table of content: VIORICA ELENA ALAWA D.O. (NPI 1679794697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679794697 NPI number — VIORICA ELENA ALAWA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAWA
Provider First Name:
VIORICA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMITTLING
Provider Other First Name:
VIORICA
Provider Other Middle Name:
ELENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679794697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867-0456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-723-2299
Provider Business Mailing Address Fax Number:
989-729-9109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-723-2299
Provider Business Practice Location Address Fax Number:
989-729-9109
Provider Enumeration Date:
05/01/2007

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: 207R00000X , with the licence number:  5101016747 , 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: 1679794697 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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