1073662730 NPI number — VALERIE K HUDSON M.D.

Table of content: VALERIE K HUDSON M.D. (NPI 1073662730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073662730 NPI number — VALERIE K HUDSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDSON
Provider First Name:
VALERIE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1073662730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
796 BEDFORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48230-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-824-9682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20440 HARPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARPER WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48225-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-640-9400
Provider Business Practice Location Address Fax Number:
313-640-8878
Provider Enumeration Date:
01/10/2007

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: 207R00000X , with the licence number:  4301060360 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 4301060360 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001452 . This is a "MIDWEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142485 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 13182 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247812 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142485 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130767800 . This is a "U.S. DEPT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104270096 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: G34915 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 761-2 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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