1891789822 NPI number — DR. GREG M. NOAH O.D.

Table of content: HARDIK P PATEL D.P.T (NPI 1144775339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891789822 NPI number — DR. GREG M. NOAH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOAH
Provider First Name:
GREG
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1891789822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 BUSINESS PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49686-8683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-947-6246
Provider Business Mailing Address Fax Number:
231-947-8864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 BUSINESS PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-947-6246
Provider Business Practice Location Address Fax Number:
231-947-8864
Provider Enumeration Date:
09/06/2005

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: 152W00000X , with the licence number:  4901003086 , 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: 900E110240 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4971770 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900E300160 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900F410030 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4971752 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00397246 . This is a "RAILROAD MEDIICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4971743 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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