1740270420 NPI number — DR. DONALD M BIRCH M.D.

Table of content: DR. DONALD M BIRCH M.D. (NPI 1740270420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740270420 NPI number — DR. DONALD M BIRCH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRCH
Provider First Name:
DONALD
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1740270420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 W TIENKEN RD
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48306-4474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-651-2640
Provider Business Mailing Address Fax Number:
248-651-2543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W TIENKEN RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48306-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-651-2640
Provider Business Practice Location Address Fax Number:
248-651-2543
Provider Enumeration Date:
10/25/2005

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: 207RH0003X , with the licence number:  DB032540 , 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: 382208290 . This is a "COMMERCIAL PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1740270420 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1106305351 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 002545307 . This is a "HIGHMARK BS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0630535 . This is a "BS PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B43435 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DB032540 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI3080 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01023109 . This is a "HEALTH PLUS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136845610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407161508 . This is a "MEDICARE TYPE 2 NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301032540 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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