1679808653 NPI number — AMBER E BUDZINSKI PAC

Table of content: AMBER E BUDZINSKI PAC (NPI 1679808653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679808653 NPI number — AMBER E BUDZINSKI PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDZINSKI
Provider First Name:
AMBER
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

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:
1679808653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38935 ANN ARBOR ROAD
Provider Second Line Business Mailing Address:
CREDENTIALING/PAYER CONTRACTING SERVICES
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48150-3397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-632-0175
Provider Business Mailing Address Fax Number:
734-632-0182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15855 NINETEEN MILE RD
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE DEPARTMENT
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-263-2601
Provider Business Practice Location Address Fax Number:
586-263-2589
Provider Enumeration Date:
10/09/2009

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: 363AM0700X , with the licence number:  5601005651 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 5601005651 , 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: 12327882 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com