1871649236 NPI number — FARZANA BUTT

Table of content: MR. ALLEN R HODGES MD (NPI 1508085440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871649236 NPI number — FARZANA BUTT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARZANA BUTT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ULTRASOUND CLINIC DIAGNOSTIC
Provider Other Organization Name Type Code:
3
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:
1871649236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 SPRING ARBOR RD
Provider Second Line Business Mailing Address:
SUITE#500
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49203-3652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-784-5150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 SPRING ARBOR RD
Provider Second Line Business Practice Location Address:
SUITE #500
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49203-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-784-5150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SADASIVAN
Authorized Official First Name:
NANJAPA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
517-784-5150

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  NS033633 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2471V0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 128472 . This is a "GLP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5970 . This is a "HPL" identifier . This identifiers is of the category "OTHER".
  • Identifier: P71951 . This is a "BCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300C810210 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1620009 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104486551 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 380030 . This is a "M CARE OP" identifier . This identifiers is of the category "OTHER".




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