1972552628 NPI number — DR. PATRICK JOSEPH DROSTE MD

Table of content: PATRICK J DAVIDSON PA-C (NPI 1548262934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972552628 NPI number — DR. PATRICK JOSEPH DROSTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROSTE
Provider First Name:
PATRICK
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972552628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5050 CASCADE RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-3725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-957-0866
Provider Business Mailing Address Fax Number:
616-956-0281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 CASCADE RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-957-0866
Provider Business Practice Location Address Fax Number:
616-956-0281
Provider Enumeration Date:
05/09/2006

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: 207W00000X , with the licence number:  047600 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0110X , with the licence number: 4301047600 , 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: 180040367 . This is a "RETIRED RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1804102032 . This is a "BLUE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2636622 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2636622 . This is a "CHILDREN SPECIAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700000215 . This is a "PRIORITY HEALTH HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M015190 . This is a "CHAMPUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1804102032 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700000215 . This is a "PRIORITY HEALTH MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1804102032 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700000215 . This is a "PRIORITY HEALTH MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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