1386754117 NPI number — MS. GERDA T MAH MA LLP

Table of content: MS. GERDA T MAH MA LLP (NPI 1386754117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386754117 NPI number — MS. GERDA T MAH MA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAH
Provider First Name:
GERDA
Provider Middle Name:
T
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LLP
Provider Gender Code:
F

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:
1386754117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2958 ORBIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48360-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-391-2043
Provider Business Mailing Address Fax Number:
248-391-0890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 W BIG BEAVER RD
Provider Second Line Business Practice Location Address:
1450
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-244-8644
Provider Business Practice Location Address Fax Number:
248-244-1330
Provider Enumeration Date:
08/30/2006

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: 103TC0700X , with the licence number:  6301000810 , 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)





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