1710945928 NPI number — SULEIKA JUST-BUDDY MICHEL M.D.

Table of content: SULEIKA JUST-BUDDY MICHEL M.D. (NPI 1710945928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710945928 NPI number — SULEIKA JUST-BUDDY MICHEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHEL
Provider First Name:
SULEIKA
Provider Middle Name:
JUST-BUDDY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1710945928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-573-9530
Provider Business Mailing Address Fax Number:
410-573-9568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-837-1221
Provider Business Practice Location Address Fax Number:
410-573-9569
Provider Enumeration Date:
05/04/2006

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:  D0059361 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VC0200X , with the licence number: D0059361 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 2785 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 596914Y5Z . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CY310012 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100233829 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 596914ZDWS . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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