1215255369 NPI number — MRS. SARAH CHRISTINE GUERTIN MA, LLP

Table of content: MRS. SARAH CHRISTINE GUERTIN MA, LLP (NPI 1215255369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215255369 NPI number — MRS. SARAH CHRISTINE GUERTIN MA, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERTIN
Provider First Name:
SARAH
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LLP
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:
1215255369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15501 METROPOLITAN PKWY
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-226-2282
Provider Business Mailing Address Fax Number:
586-226-2833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15501 METROPOLITAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-226-2282
Provider Business Practice Location Address Fax Number:
586-226-2833
Provider Enumeration Date:
05/13/2010

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: 103TC0700X , with the licence number:  6301014349 , 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: 750910681 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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