1013009901 NPI number — DR. FREDRIC I NEUMANN I D.O.

Table of content: DR. FREDRIC I NEUMANN I D.O. (NPI 1013009901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013009901 NPI number — DR. FREDRIC I NEUMANN I D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUMANN
Provider First Name:
FREDRIC
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
D.O.
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:
1013009901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39880 VAN DYKE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-939-9060
Provider Business Mailing Address Fax Number:
586-939-6639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39880 VAN DYKE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-939-9060
Provider Business Practice Location Address Fax Number:
586-939-6639
Provider Enumeration Date:
09/28/2006

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: 207Q00000X , with the licence number:  FN009587 , 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: P9044 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 08-0-E0-1042 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 43253579 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3229747 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080082386 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383277109 . This is a "TAX IDENIFICATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 23D0371615 . This is a "CLIA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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