1740256064 NPI number — MICHAEL FREDERICK BAHNTGE MD

Table of content: MICHAEL FREDERICK BAHNTGE MD (NPI 1740256064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740256064 NPI number — MICHAEL FREDERICK BAHNTGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAHNTGE
Provider First Name:
MICHAEL
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1740256064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20525 CENTER RIDGE RD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-895-5056
Provider Business Mailing Address Fax Number:
440-333-2935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 METROHEALTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-778-3958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006

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: 2084N0400X , with the licence number:  35048477B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11046868 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: D368301 . This is a "GROUP IND DIAGNOSTICS MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9273172 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0119204 . This is a "GROUP MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0587931 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780634279 . This is a "GROUPNPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4326122 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "GROUP RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000276513 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0501231 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341783789031 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C78477 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3610861 . This is a "GROUP ASC MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103647 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130026262 . This is a "RR MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




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