1164938494 NPI number — NUCH OF MICHIGAN INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164938494 NPI number — NUCH OF MICHIGAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUCH OF MICHIGAN INC
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:
MEDPOST - STERLING HEIGHTS
Provider Other Organization Name Type Code:
3
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:
1164938494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 EASTPARK DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-600-4074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36765 VAN DYKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48312-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-382-9560
Provider Business Practice Location Address Fax Number:
586-382-9561
Provider Enumeration Date:
12/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ENDERLE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED SIGNATORY
Authorized Official Telephone Number:
615-600-4120

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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