1134248784 NPI number — BRENDA M CARNAGHI DPM

Table of content: BRENDA M CARNAGHI DPM (NPI 1134248784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134248784 NPI number — BRENDA M CARNAGHI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNAGHI
Provider First Name:
BRENDA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1134248784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 W SOUTH BLVD
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48085-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-585-1177
Provider Business Mailing Address Fax Number:
248-585-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 W SOUTH BLVD STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48085-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-509-7086
Provider Business Practice Location Address Fax Number:
248-289-1853
Provider Enumeration Date:
03/28/2007

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: 213E00000X , with the licence number:  5901002250 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 5901002250 , 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: 383749866 . This is a "BEAUMONT EMPLOYEE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383749866 . This is a "COFINITY PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: BC002250 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11342487884 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: BC002250 . This is a "MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: BC002250 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2845210-03 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383749866 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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