1235284233 NPI number — DR. DINESH NAYAK, MD, P.C.

Table of content: (NPI 1235284233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235284233 NPI number — DR. DINESH NAYAK, MD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DINESH NAYAK, MD, 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:
6
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:
1235284233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15255 NORTHLINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHGATE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48195-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-285-3090
Provider Business Mailing Address Fax Number:
734-285-3095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15255 NORTHLINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHGATE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48195-2487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-285-3090
Provider Business Practice Location Address Fax Number:
734-285-3095
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAYAK
Authorized Official First Name:
DINESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF THE CORPORATION
Authorized Official Telephone Number:
734-285-3090

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  DN065279 , 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: C7880 . This is a "MCARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4433530 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022809 . This is a "MIDWEST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132436 . This is a "CARE CHOICES ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5885732 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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