1235195231 NPI number — ALISON ERIKA GILBERT AUD

Table of content: ALISON ERIKA GILBERT AUD (NPI 1235195231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235195231 NPI number — ALISON ERIKA GILBERT AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT
Provider First Name:
ALISON
Provider Middle Name:
ERIKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINHARDT
Provider Other First Name:
ALISON
Provider Other Middle Name:
ERIKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235195231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT 272801
Provider Second Line Business Mailing Address:
PO BOX 67000
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-841-6913
Provider Business Mailing Address Fax Number:
517-841-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 TENEYCK ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-1468
Provider Business Practice Location Address Fax Number:
517-787-0613
Provider Enumeration Date:
04/26/2006

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: 231H00000X , with the licence number:  1601000038 , 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: 4697565 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00085811 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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