1558307926 NPI number — E MICHAEL LODISH DO PC

Table of content: (NPI 1558307926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558307926 NPI number — E MICHAEL LODISH DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E MICHAEL LODISH DO 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:
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:
1558307926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3272 E 12 MILE RD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48092-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-573-3127
Provider Business Mailing Address Fax Number:
586-573-3130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3272 E 12 MILE RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48092-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-573-3127
Provider Business Practice Location Address Fax Number:
586-573-3130
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LODISH
Authorized Official First Name:
E
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-573-3127

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118395 . This is a "GREATLAKEHEALTHPLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M004233 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0255011674 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1899208 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49119 . This is a "OMNICARE COVENTRY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000003077 . This is a "CAPEHEALTHPLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 107509 . This is a "CARECHOICES/PREFERREDCHOI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3689470001 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E37392 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1533202 . This is a "UNITED MINEWORKERS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4110309 . This is a "AETNA PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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