1699090415 NPI number — PALANIANDY K KOGULAN MD PLLC

Table of content: (NPI 1699090415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699090415 NPI number — PALANIANDY K KOGULAN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALANIANDY K KOGULAN 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:
1699090415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3785 BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-791-2455
Provider Business Mailing Address Fax Number:
989-791-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 HALLMARK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48603-2173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-793-4420
Provider Business Practice Location Address Fax Number:
989-791-7068
Provider Enumeration Date:
04/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KOGULAN
Authorized Official First Name:
PALANIANDY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
989-791-7085

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  4301082867 , 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: 1255436309 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00838756 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01028605 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0730504 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI2987001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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