1982796488 NPI number — DR. AMANDA J TOOLE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982796488 NPI number — DR. AMANDA J TOOLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOLE
Provider First Name:
AMANDA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1982796488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21000 E 12 MILE RD
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
ST CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-226-4301
Provider Business Mailing Address Fax Number:
586-445-2523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21000 E 12 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SAINT CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-779-7610
Provider Business Practice Location Address Fax Number:
586-445-2523
Provider Enumeration Date:
09/29/2006

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: 207YX0007X , with the licence number:  AT077352 , 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: 104263 . This is a "GREAT LAKES" identifier . This identifiers is of the category "OTHER".
  • Identifier: H31309 . This is a "HEALTH ALLIANCE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7246248 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C7547 . This is a "MCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0405011091 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131198 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4112028002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0501109 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4284574 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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