1508862707 NPI number — DR. ALLEN S MEHLER DPM

Table of content: DR. ALLEN S MEHLER DPM (NPI 1508862707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508862707 NPI number — DR. ALLEN S MEHLER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHLER
Provider First Name:
ALLEN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1508862707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14555 LEVAN RD
Provider Second Line Business Mailing Address:
STE E302
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48154-5083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-591-6612
Provider Business Mailing Address Fax Number:
734-591-6625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14555 LEVAN RD
Provider Second Line Business Practice Location Address:
STE E302
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48154-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-591-6612
Provider Business Practice Location Address Fax Number:
734-591-6625
Provider Enumeration Date:
06/22/2005

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: 213E00000X , with the licence number:  5901000946 , 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: 480029297 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4188219-13 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C7510 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4188219 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 506087 . This is a "CARECHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 506087 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: T97182 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101992 . This is a "GREATLAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000004895 . This is a "CAPE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 136148700 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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