1881691178 NPI number — DR. CHRISTIAN WILLIAM ERTL MD

Table of content: (NPI 1134124258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881691178 NPI number — DR. CHRISTIAN WILLIAM ERTL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERTL
Provider First Name:
CHRISTIAN
Provider Middle Name:
WILLIAM
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:
1881691178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 OAKLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49008-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-337-6260
Provider Business Mailing Address Fax Number:
269-337-6441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 OAKLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49008-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-337-6260
Provider Business Practice Location Address Fax Number:
269-337-6530
Provider Enumeration Date:
07/01/2005

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: 208600000X , with the licence number:  4301093343 , 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: 1881691178 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2386462 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 149696 . This is a "PREFERRED ONE HUSKY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010036846CT01 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417961137 . This is a "BCBSM - BRONSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 03684601 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00136846501 . This is a "BLUE CARE FAMILY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V7800 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P984485 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020001475 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061596829 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740406 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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