1639105760 NPI number — SMITA BIJLANI MD PC

Table of content: (NPI 1639105760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639105760 NPI number — SMITA BIJLANI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITA BIJLANI MD 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:
ROCHESTER ENDOCRINOLOGY & DIABETES CENTER
Provider Other Organization Name Type Code:
3
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:
1639105760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 BARCLAY CIR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-4599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-853-7270
Provider Business Mailing Address Fax Number:
248-853-7230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 BARCLAY CIR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-853-7270
Provider Business Practice Location Address Fax Number:
248-853-7230
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIJLANI
Authorized Official First Name:
SMITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-853-7270

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6551339 . This is a "MEDICAID OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 110F324280 . This is a "BCBS OF MI GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1639105760 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110F324280 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DD9856 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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