1558754952 NPI number — MICHAEL ADERMAN

Table of content: MICHAEL ADERMAN (NPI 1558754952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558754952 NPI number — MICHAEL ADERMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADERMAN
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1558754952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
S DAKOTA STATE UNIVERSITY
Provider Second Line Business Mailing Address:
2820 HPER CENTER
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57007-1497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-688-4003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
S DAKOTA STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
2820 HPER CENTER
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57007-1497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-688-4003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2015

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: 2255A2300X , with the licence number:  0001259 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0482 . This is a "SDBMOE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 2000013908 . This is a "BOC" identifier . This identifiers is of the category "OTHER".