1851342968 NPI number — DR. GEORGE A MORESEA MD

Table of content: DR. GEORGE A MORESEA MD (NPI 1851342968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851342968 NPI number — DR. GEORGE A MORESEA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORESEA
Provider First Name:
GEORGE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1851342968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 W MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-6440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4665 DOUGLAS CIR NW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-3673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-499-5700
Provider Business Practice Location Address Fax Number:
330-498-4229
Provider Enumeration Date:
05/13/2006

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: 207L00000X , with the licence number:  35072464 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2027489 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050050517 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000135913 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".