1003068016 NPI number — NITIN K.G.GOLECHHA MD,PC.

Table of content: (NPI 1003068016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003068016 NPI number — NITIN K.G.GOLECHHA MD,PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NITIN K.G.GOLECHHA 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:
1003068016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2734 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48453-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-635-1871
Provider Business Mailing Address Fax Number:
989-635-1872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2734 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48453-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-635-1871
Provider Business Practice Location Address Fax Number:
989-635-1872
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOLECHHA
Authorized Official First Name:
NITIN
Authorized Official Middle Name:
K.G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-635-1871

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301071011 , 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: 1003068016 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: MI1199 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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