1811437718 NPI number — MRS. LATEEFAH RICHELLE ZISCHKE CNM

Table of content: MRS. LATEEFAH RICHELLE ZISCHKE CNM (NPI 1811437718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811437718 NPI number — MRS. LATEEFAH RICHELLE ZISCHKE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZISCHKE
Provider First Name:
LATEEFAH
Provider Middle Name:
RICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARBER
Provider Other First Name:
LATEEFAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811437718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4137 OLD DOMINION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48323-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-333-1475
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9015 JOSEPH CAMPAU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMTRAMCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-664-0777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2017

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: 367A00000X , with the licence number:  4704279173 , 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)





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