1467431742 NPI number — MANUS L KRASMAN M.D.

Table of content: MANUS L KRASMAN M.D. (NPI 1467431742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467431742 NPI number — MANUS L KRASMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRASMAN
Provider First Name:
MANUS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1467431742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 ELLIOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-8632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-434-6262
Provider Business Mailing Address Fax Number:
734-712-2820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 ELLIOTT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-8632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-434-6262
Provider Business Practice Location Address Fax Number:
734-712-2820
Provider Enumeration Date:
01/13/2006

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: 207RG0100X , with the licence number:  036613 , 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: 0M86720001 , issued by the state of ( MI ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 4332056 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0811066 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1539221 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0H14989 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F00467 , issued by the state of ( MI ) . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 019733 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2364775001 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 100003581 . This is a "MEDICARE RAILROAD PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M86730001 , issued by the state of ( MI ) . This identifiers is of the category "MEDICARE PIN".