1144313107 NPI number — CHERYL HOPE HACK M.D.

Table of content: (NPI 1720265424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144313107 NPI number — CHERYL HOPE HACK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HACK
Provider First Name:
CHERYL
Provider Middle Name:
HOPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1144313107
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:
25219 W ROYCOURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48070-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-542-0660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30301 WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE LL 165
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-0979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-435-9240
Provider Business Practice Location Address Fax Number:
248-435-4765
Provider Enumeration Date:
10/02/2006

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: 2080P0006X , with the licence number:  4301049051 , 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: 41049 . This is a "OMNICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4171928 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11277774 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004387354 . This is a "AETNA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2199 . This is a "CAPE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3506336142 . This is a "BCBS PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1003675 . This is a "WELLNESS" identifier . This identifiers is of the category "OTHER".




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