1518027929 NPI number — DR. SHAUNA RYDER DIGGS M.D.,P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518027929 NPI number — DR. SHAUNA RYDER DIGGS M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIGGS
Provider First Name:
SHAUNA
Provider Middle Name:
RYDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,P.C.
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:
1518027929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-0293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-882-5777
Provider Business Mailing Address Fax Number:
313-882-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17000 KERCHEVAL AVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
GROSSE POINTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48230-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-882-5777
Provider Business Practice Location Address Fax Number:
313-882-5776
Provider Enumeration Date:
12/08/2006

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: 207N00000X , with the licence number:  4301064244 , 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)





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