1245223528 NPI number — MICHAEL DOUGLAS PAPSON DPM

Table of content: MARKEISHA SIDDELL (NPI 1407500879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245223528 NPI number — MICHAEL DOUGLAS PAPSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAPSON
Provider First Name:
MICHAEL
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1245223528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 W LAKE LANSING RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-8528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-853-7500
Provider Business Mailing Address Fax Number:
517-853-0142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 W LAKE LANSING RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-853-7500
Provider Business Practice Location Address Fax Number:
517-853-0142
Provider Enumeration Date:
08/23/2005

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: 213E00000X , with the licence number:  5901001875 , 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: 4134862 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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