1932185071 NPI number — MR. KEITH A NUSBAUM R.PH

Table of content: MR. KEITH A NUSBAUM R.PH (NPI 1932185071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932185071 NPI number — MR. KEITH A NUSBAUM R.PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUSBAUM
Provider First Name:
KEITH
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH
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:
1932185071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1535 GRANT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45840-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-422-6343
Provider Business Mailing Address Fax Number:
419-422-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESHLER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43516-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-278-1851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2005

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: 183500000X , with the licence number:  03-1-10171 , 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)