1194828251 NPI number — JOSEPH V COTRONEO MD

Table of content: JOSEPH V COTRONEO MD (NPI 1194828251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194828251 NPI number — JOSEPH V COTRONEO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTRONEO
Provider First Name:
JOSEPH
Provider Middle Name:
V
Provider Name Prefix Text:
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:
1194828251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 W GREENLAWN AVE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48910-2898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-483-4869
Provider Business Mailing Address Fax Number:
517-483-4861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 W GREENLAWN AVE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-2898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-483-4869
Provider Business Practice Location Address Fax Number:
517-483-4861
Provider Enumeration Date:
09/06/2006

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: 208G00000X , with the licence number:  4301069411 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 4301069411 , 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: 1018867 . This is a "HEALTH ADVANTAGE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4840124 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330C313780 . This is a "BLUE CROSS TRADITIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1018867 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 330C313780 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 330C313780 . This is a "BLUE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 300C313780 . This is a "BLUE CROSS COMMUNITY BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 330C313780 . This is a "BLUE PREFERRED PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1800008 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B18332 . This is a "HEALTH NET" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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