1679747091 NPI number — SAIB ISTERABADI MD

Table of content: LINDA EVELYN MENDOZA NURSE PRACTITIONER (NPI 1588949887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679747091 NPI number — SAIB ISTERABADI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAIB ISTERABADI MD
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:
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:
1679747091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2750 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MARLETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48453-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-635-3295
Provider Business Mailing Address Fax Number:
989-635-7384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 BOYNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48453-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-635-3295
Provider Business Practice Location Address Fax Number:
989-635-7384
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ISTERABADI
Authorized Official First Name:
SAIB
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSCIAN
Authorized Official Telephone Number:
989-635-3295

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  SI034846 , 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: 0207634391 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1086921 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0207364391 . This is a "ARIZONA PHYSICIANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101285 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01004157 . This is a "HEALTH PLUS PARTNERS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P41410 . This is a "BLUECARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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