1629063029 NPI number — HELENE LACOSTE MD

Table of content: HELENE LACOSTE MD (NPI 1629063029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629063029 NPI number — HELENE LACOSTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACOSTE
Provider First Name:
HELENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629063029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-662-4388
Provider Business Mailing Address Fax Number:
248-662-3025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-662-4388
Provider Business Practice Location Address Fax Number:
248-662-3025
Provider Enumeration Date:
09/13/2005

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: 207V00000X , with the licence number:  4301051294 , 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: C6209 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 146471 . This is a "GLHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1606316561 . This is a "BLUE CROSS INDIVIDUAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160H22100 . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104457308-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4558937 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 102492 . This is a "CARECHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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