1396747572 NPI number — DR. DEBORAH LYNN PEERY M.D.

Table of content: DR. DEBORAH LYNN PEERY M.D. (NPI 1396747572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396747572 NPI number — DR. DEBORAH LYNN PEERY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEERY
Provider First Name:
DEBORAH
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1396747572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 W BENNETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48176-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-429-9377
Provider Business Mailing Address Fax Number:
734-429-8277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W BENNETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48176-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-429-9377
Provider Business Practice Location Address Fax Number:
734-429-8277
Provider Enumeration Date:
06/01/2005

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: 207R00000X , with the licence number:  DP048839 , 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: 382742669 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382742669 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 027980 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382742669 . This is a "UNITED HEALTHCARE PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382742669 . This is a "WASHTENAW HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N14060 . This is a "MICHIGAN MEDICARE PLUS BL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382742669 . This is a "COFINITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: A74234 . This is a "HEALTH ALLIANCE PLAN HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0813416 . This is a "BLUE CARE NETWORK OF MICH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108134161 . This is a "BCBS OF MICHIGAN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382742669 . This is a "MICHIGAN TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DP048839 . This is a "MICHIGAN STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101812233 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A5035098 . This is a "AETNA PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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