1841357530 NPI number — JENNIFER LYNN SOMERS DPM

Table of content: ANNA FYODOROVA DPT (NPI 1437200250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841357530 NPI number — JENNIFER LYNN SOMERS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMERS
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1841357530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6483 CITATION DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-2994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-751-1025
Provider Business Mailing Address Fax Number:
248-922-9368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6483 CITATION DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48346-2994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-751-1025
Provider Business Practice Location Address Fax Number:
248-922-9368
Provider Enumeration Date:
01/02/2007

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: 213ES0103X , with the licence number:  5901002185 , 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: 1841357530 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480E015590 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 135073500 . This is a "WORKER COMPENSATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 811546797 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00405158 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5901002185 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160088 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6U5660 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7840927 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DB8851 . This is a "RAIL ROAD MEDICARE GRP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0E06293 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4855010950 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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