1255447660 NPI number — LAURENCE J VERLINDEN M.D.

Table of content: LAURENCE J VERLINDEN M.D. (NPI 1255447660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255447660 NPI number — LAURENCE J VERLINDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERLINDEN
Provider First Name:
LAURENCE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1255447660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54221-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-320-4500
Provider Business Mailing Address Fax Number:
920-682-9378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 S 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-7316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-4500
Provider Business Practice Location Address Fax Number:
920-682-9378
Provider Enumeration Date:
08/21/2006

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: 207Q00000X , with the licence number:  26067 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B57329 . This is a "CIGNA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 26067 . This is a "TOUCHPOINT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 390806395 . This is a "CHAMPUS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 390806395 . This is a "WEA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39080639508 . This is a "TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 080071913 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 30588300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9309 . This is a "NETWORK HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000158646 02 . This is a "UNITED HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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