1790778363 NPI number — RAKESH N SAXENA MD PC

Table of content: EBONY DIANE WHITE (NPI 1194248849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790778363 NPI number — RAKESH N SAXENA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAKESH N SAXENA MD PC
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:
1790778363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 E WARWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48801-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-463-4976
Provider Business Mailing Address Fax Number:
989-463-2249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 E WARWICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48801-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-463-4976
Provider Business Practice Location Address Fax Number:
989-463-2249
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SAXENA
Authorized Official First Name:
RAKESH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-463-4976

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  4310032524 (ACTIVE) , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: 0419873 (INACTIVE) , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 82307 (INACTIVE LIC) , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0400990 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1102943802 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 09497A . This is a "MID MI HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1071464 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1102058586 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: M002396 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1005137 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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