1265543318 NPI number — OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265543318 NPI number — OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C.
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:
OBGAP
Provider Other Organization Name Type Code:
5
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:
1265543318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2725 WARNER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
W BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48324-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-360-7797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 S TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-0285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-335-9207
Provider Business Practice Location Address Fax Number:
248-335-2394
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
TELESFORO
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-335-9207

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  430103648 , 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: 10-4520161 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-4170054 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-4609965 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104170036 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-4170027 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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