1063498319 NPI number — DR. CARL C SARNACKI MD

Table of content: DR. CARL C SARNACKI MD (NPI 1063498319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063498319 NPI number — DR. CARL C SARNACKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARNACKI
Provider First Name:
CARL
Provider Middle Name:
C
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:
1063498319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 S LAPEER RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48360-1467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-693-3551
Provider Business Mailing Address Fax Number:
248-693-4643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1455 S LAPEER RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LAKE ORION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48360-1467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-693-3551
Provider Business Practice Location Address Fax Number:
248-693-4643
Provider Enumeration Date:
12/19/2005

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: 207Q00000X , with the licence number:  4301055099 , 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: 0806364931 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 120397 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4480905 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0806337511 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00392314 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F30122 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0806364931 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0806337511 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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