1497741177 NPI number — DR. ARDESHIR IRANI MD

Table of content: DR. ARDESHIR IRANI MD (NPI 1497741177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497741177 NPI number — DR. ARDESHIR IRANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRANI
Provider First Name:
ARDESHIR
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1497741177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
04/13/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 W HIGHLAND RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48357-4504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-773-1823
Provider Business Mailing Address Fax Number:
586-773-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W HIGHLAND RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48357-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-773-1823
Provider Business Practice Location Address Fax Number:
586-773-1211
Provider Enumeration Date:
09/27/2005

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: 208000000X , with the licence number:  AI064238 , 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: 4343844 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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