1427089200 NPI number — VIPIN KHETARPAL MD

Table of content: VIPIN KHETARPAL MD (NPI 1427089200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427089200 NPI number — VIPIN KHETARPAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHETARPAL
Provider First Name:
VIPIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1427089200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 S. WASHINGTON AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48601
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
989-754-3000
Provider Business Mailing Address Fax Number:
989-755-1365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-754-3000
Provider Business Practice Location Address Fax Number:
989-755-1365
Provider Enumeration Date:
07/06/2006

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: 207R00000X , with the licence number:  4301062327 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 4301062327 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 4301062327 , 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: 381908328 . This is a "PPOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700G361110 . This is a "BLUE CARE NETWORK MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003216 . This is a "MCLAREN HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110192800 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328112 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4122001 . This is a "MOLINA HEALTH CARE MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123064 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TYPE 77 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09885594 . This is a "HEALTHPLUS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003216 . This is a "HEALTH ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "HCAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700G361110 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7151013 . This is a "AETNA UNDER ID 381908328" identifier . This identifiers is of the category "OTHER".




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