1679794697 NPI number — VIORICA ELENA ALAWA D.O.

Table of content: MICHAEL BRIAN STUCK PA-C (NPI 1538872247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679794697 NPI number — VIORICA ELENA ALAWA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAWA
Provider First Name:
VIORICA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMITTLING
Provider Other First Name:
VIORICA
Provider Other Middle Name:
ELENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679794697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867-0456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-723-2299
Provider Business Mailing Address Fax Number:
989-729-9109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-723-2299
Provider Business Practice Location Address Fax Number:
989-729-9109
Provider Enumeration Date:
05/01/2007

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: 207R00000X , with the licence number:  5101016747 , 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: 1679794697 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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