1568894558 NPI number — MS. KRISELLE MARIS NOBLESA LAO M.D.

Table of content: MS. KRISELLE MARIS NOBLESA LAO M.D. (NPI 1568894558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568894558 NPI number — MS. KRISELLE MARIS NOBLESA LAO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAO
Provider First Name:
KRISELLE MARIS
Provider Middle Name:
NOBLESA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1568894558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9D, GREENRICH M.,
Provider Second Line Business Mailing Address:
LOURDES ST., ORTIGAS CENTER
Provider Business Mailing Address City Name:
PASIG
Provider Business Mailing Address State Name:
PHILIPPINES
Provider Business Mailing Address Postal Code:
001605
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 W 13 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-898-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2013

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: 207ZP0104X , with the licence number:  61465 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 61465 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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