1336311257 NPI number — MARGARET O AJAYI-NABORS PHP

Table of content: MARGARET O AJAYI-NABORS PHP (NPI 1336311257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336311257 NPI number — MARGARET O AJAYI-NABORS PHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AJAYI-NABORS
Provider First Name:
MARGARET
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AJAYI
Provider Other First Name:
MARGARET
Provider Other Middle Name:
O
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:
1336311257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 W MILHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49024-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-312-8686
Provider Business Mailing Address Fax Number:
269-220-5333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49007-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-206-1480
Provider Business Practice Location Address Fax Number:
269-366-4946
Provider Enumeration Date:
03/31/2008

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: 103T00000X , with the licence number:  6301012355 , 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)





Copyright © 2007-2024 www.npivalidator.com