1902002256 NPI number — THERESA LOUISE PATLEWICZ BS, SST

Table of content: THERESA LOUISE PATLEWICZ BS, SST (NPI 1902002256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902002256 NPI number — THERESA LOUISE PATLEWICZ BS, SST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATLEWICZ
Provider First Name:
THERESA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, SST
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:
1902002256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35919 WOODRIDGE CIR
Provider Second Line Business Mailing Address:
APT. 104
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48335-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-354-4641
Provider Business Mailing Address Fax Number:
586-792-1656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35555 GARFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48035-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-792-1654
Provider Business Practice Location Address Fax Number:
586-792-1656
Provider Enumeration Date:
06/25/2007

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: 104100000X , with the licence number:  6803085445 , 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)





Copyright © 2007-2024 www.npivalidator.com