1861169872 NPI number — MR. FUAD JEILANI

Table of content: MICHAEL A AROCHO M.D. (NPI 1972665156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861169872 NPI number — MR. FUAD JEILANI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEILANI
Provider First Name:
FUAD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1861169872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12279
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48901-2279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-245-4777
Provider Business Mailing Address Fax Number:
517-698-8223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1632 TOWN COMMONS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48855-6804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-245-4778
Provider Business Practice Location Address Fax Number:
517-698-8223
Provider Enumeration Date:
08/26/2021

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: J450264029686 . This is a "BEHAVIOR ANALYST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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