1255394813 NPI number — LUNG ASSOCIATES PC

Table of content: (NPI 1255394813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255394813 NPI number — LUNG ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNG ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255394813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 S JOHNSON
Provider Second Line Business Mailing Address:
STE 1D
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-332-0995
Provider Business Mailing Address Fax Number:
248-332-2470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 S JOHNSON
Provider Second Line Business Practice Location Address:
STE 1D
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-332-0995
Provider Business Practice Location Address Fax Number:
248-332-2470
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
AVINASH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICER OWNER
Authorized Official Telephone Number:
248-332-2470

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11OF37790 . This is a "BS - GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com