1871772848 NPI number — BARBARA D SAXENA MD PLLC

Table of content: (NPI 1871772848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871772848 NPI number — BARBARA D SAXENA MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA D SAXENA 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:
1871772848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48908-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-622-1814
Provider Business Mailing Address Fax Number:
517-268-6609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 CHARLEVOIX DR
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
GRAND LEDGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48837-8186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-622-1814
Provider Business Practice Location Address Fax Number:
517-268-6609
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAXENA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-622-1814

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  BS060808 , 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: 366766342 . This is a "SS#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0802300382 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: BS060808 . This is a "LIC #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4086317 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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