1548442858 NPI number — DAVID R HUNTER DPM PC

Table of content: (NPI 1548442858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548442858 NPI number — DAVID R HUNTER DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID R HUNTER DPM PC
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:
NORTHERN MICHIGAN FOOT SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1548442858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 MITCHELL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETOSKEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49770-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-347-3440
Provider Business Mailing Address Fax Number:
231-347-4828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 ASHMUN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAULT SAINTE MARIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49783-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-635-9511
Provider Business Practice Location Address Fax Number:
906-635-9529
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
231-347-3440

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DH5901001212 , 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: 1310710002 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0B44565 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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