1912998394 NPI number — MRS. MARY JO K VOELPEL D.O.

Table of content: MRS. MARY JO K VOELPEL D.O. (NPI 1912998394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912998394 NPI number — MRS. MARY JO K VOELPEL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOELPEL
Provider First Name:
MARY JO
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1912998394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 318
Provider Second Line Business Mailing Address:
3003 S. BALDWIN RD. SUITE A
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-391-9220
Provider Business Mailing Address Fax Number:
248-391-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 S. BALDWIN RD.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAKE ORION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-391-9220
Provider Business Practice Location Address Fax Number:
248-391-9224
Provider Enumeration Date:
11/03/2005

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: 207RH0003X , with the licence number:  MV006984 , 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: 122064-0003 . This is a "WELLNESS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 23D089621 . This is a "CLIA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103416 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103779 . This is a "CARE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00061141 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4217 . This is a "CAPE HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P44577 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4441531 . This is a "TEAMSTERS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1156300864 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C4930 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: (11)4509816 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383460440 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50016867 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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