1194918425 NPI number — MICHIGAN VISITING DOCTORS P C

Table of content: (NPI 1194918425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194918425 NPI number — MICHIGAN VISITING DOCTORS P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN VISITING DOCTORS P C
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:
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:
1194918425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48308-1280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-575-4500
Provider Business Mailing Address Fax Number:
248-375-8888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 S CHRISTIAN HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48309-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-575-4500
Provider Business Practice Location Address Fax Number:
248-375-8888
Provider Enumeration Date:
08/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALMEDA
Authorized Official First Name:
ISIDRO
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-575-4500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IA032452 , 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)