1619008109 NPI number — ARLEEN DENISE HARRIS BLYTHE R.D.

Table of content: ARLEEN DENISE HARRIS BLYTHE R.D. (NPI 1619008109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619008109 NPI number — ARLEEN DENISE HARRIS BLYTHE R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS BLYTHE
Provider First Name:
ARLEEN
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.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:
1619008109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1151 TAYLOR STREET, 2-C WING
Provider Second Line Business Mailing Address:
DETROIT HEALTH DEPARTMENT - HERMAN KIEFER HEALTH COMPLE
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-876-4558
Provider Business Mailing Address Fax Number:
313-876-4645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DETROIT HEALTH DEPT - HERMAN KIEFER HEALTH COMPLEX
Provider Second Line Business Practice Location Address:
1151 TAYLOR STREET, WING , 2C
Provider Business Practice Location Address City Name:
DETRIOT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-876-4558
Provider Business Practice Location Address Fax Number:
313-876-4645
Provider Enumeration Date:
03/08/2007

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: 133NN1002X , with the licence number:  R357296 , 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)





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