1194758870 NPI number — DR. ERNEST WEAVER LEFEVER DPM

Table of content: DR. ERNEST WEAVER LEFEVER DPM (NPI 1194758870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194758870 NPI number — DR. ERNEST WEAVER LEFEVER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEFEVER
Provider First Name:
ERNEST
Provider Middle Name:
WEAVER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1194758870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1390 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPEER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48446-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-664-1250
Provider Business Mailing Address Fax Number:
810-664-0315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-664-1250
Provider Business Practice Location Address Fax Number:
810-664-0315
Provider Enumeration Date:
07/08/2006

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: 213ES0103X , with the licence number:  5901000925 , 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: 1001820 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5445001 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5445001 . This is a "BLUE CARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001820 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C6286 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4313308 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5410482 . This is a "HEALTH PLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5445001 . This is a "BLUE CROSS INDIVIDUAL I.D" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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