1043295066 NPI number — DR. ALGIMANTAS P MACIULIS MD

Table of content: DR. ALGIMANTAS P MACIULIS MD (NPI 1043295066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043295066 NPI number — DR. ALGIMANTAS P MACIULIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACIULIS
Provider First Name:
ALGIMANTAS
Provider Middle Name:
P
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:
1043295066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S. WENONA ST.
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-894-6040
Provider Business Mailing Address Fax Number:
989-892-3983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S. WENONA ST
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-894-6040
Provider Business Practice Location Address Fax Number:
989-892-3983
Provider Enumeration Date:
12/13/2005

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: 207RR0500X , with the licence number:  4301056481 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: AM056481 , 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: 2678097 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1100975472 . This is a "BCR & BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com