1831192483 NPI number — DR. MARY ANNE PURTILL M.D.

Table of content: (NPI 1891207171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192483 NPI number — DR. MARY ANNE PURTILL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURTILL
Provider First Name:
MARY ANNE
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1831192483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPARTMENT 272801
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-817-7605
Provider Business Mailing Address Fax Number:
517-817-7606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-817-7605
Provider Business Practice Location Address Fax Number:
517-817-7606
Provider Enumeration Date:
05/27/2005

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: 2086S0127X , with the licence number:  4301075397 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: G076836 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZP4310Z . This is a "MEDICARE ID - STANFORD SURGERY DEPT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com