1235390527 NPI number — DR. CAREY CHICOREL LINDEN M.D.

Table of content: DR. CAREY CHICOREL LINDEN M.D. (NPI 1235390527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235390527 NPI number — DR. CAREY CHICOREL LINDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDEN
Provider First Name:
CAREY
Provider Middle Name:
CHICOREL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHICOREL
Provider Other First Name:
CAREY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235390527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31730 HOOVER RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48093-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-268-9222
Provider Business Mailing Address Fax Number:
586-268-9226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31730 HOOVER RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-268-9222
Provider Business Practice Location Address Fax Number:
586-268-9226
Provider Enumeration Date:
06/19/2008

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: 207K00000X , with the licence number:  4301091401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 4301091401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0305024781 . This is a "BCN IND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1235390527 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0305024781 . This is a "BCBS IND PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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