1518104124 NPI number — CHOWDHURY MD PLLC

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 1518104124 NPI number — CHOWDHURY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOWDHURY MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1518104124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8795 PINE RIDGE DR
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
CADILLAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49601-9777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-779-9960
Provider Business Mailing Address Fax Number:
231-779-8945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8795 PINE RIDGE DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
CADILLAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49601-9777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-779-9960
Provider Business Practice Location Address Fax Number:
231-779-8945
Provider Enumeration Date:
01/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHOWDHURY
Authorized Official First Name:
SHOAIB
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
231-779-9960

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 4301078654 , 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: 1108300652 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 433661610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110H310810 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com