1821182023 NPI number — DR. INGRID M STINES DPM, FACFAS

Table of content: DR. INGRID M STINES DPM, FACFAS (NPI 1821182023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821182023 NPI number — DR. INGRID M STINES DPM, FACFAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STINES
Provider First Name:
INGRID
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM, FACFAS
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:
1821182023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3955 PATIENT CARE WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48911-4299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-374-7600
Provider Business Mailing Address Fax Number:
517-374-7659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3955 PATIENT CARE WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48911-4299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-374-7600
Provider Business Practice Location Address Fax Number:
517-374-7659
Provider Enumeration Date:
10/03/2006

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: 213ES0103X , with the licence number:  IS001340 , 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: 1821182023 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1066979 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000032680 . This is a "PHP OF MID MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4061788 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4853312980 . This is a "BLUE CROSS BLUE SHIELD/BLUE CARE NETWORK OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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