1124054341 NPI number — LISA K BARANCIN P.A.

Table of content: LISA K BARANCIN P.A. (NPI 1124054341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124054341 NPI number — LISA K BARANCIN P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARANCIN
Provider First Name:
LISA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

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:
1124054341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPT 272801
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-841-7490
Provider Business Mailing Address Fax Number:
517-841-6913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8958 M 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONSTED
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49265-9461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-467-4424
Provider Business Practice Location Address Fax Number:
517-467-2226
Provider Enumeration Date:
06/23/2006

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: 363A00000X , with the licence number:  5601004295 , 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)