1962635169 NPI number — ALLEN SILBERGLEIT MD PC

Table of content: (NPI 1962635169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962635169 NPI number — ALLEN SILBERGLEIT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN SILBERGLEIT MD PC
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:
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:
1962635169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44555 WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341-5031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-335-6433
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44555 WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-5031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-335-6433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SILBERGLEIT
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-335-6433

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1962635169 . This is a "NPI GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1992871255 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2025448 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3306380811 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".