1245235654 NPI number — JOHN IMAD JARAD M.D.

Table of content: AMY R HALE DAYE (NPI 1053094029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245235654 NPI number — JOHN IMAD JARAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARAD
Provider First Name:
JOHN
Provider Middle Name:
IMAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1245235654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2540 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT HURON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48060-6405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-987-1000
Provider Business Mailing Address Fax Number:
810-982-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2540 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-6405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-987-1000
Provider Business Practice Location Address Fax Number:
810-982-1810
Provider Enumeration Date:
06/14/2005

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: 207RG0300X , with the licence number:  061093 , 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: 0994185 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G35455 . This is a "HAP/CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P225700002 . This is a "MEDICARE PROVIDER PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105910404081 . This is a "HUMANA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2366756 . This is a "AETNA MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DG3605 . This is a "RAILROAD MEDICARE GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G35455 . This is a "ALLIANCE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417675 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900040508 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110196407 . This is a "RAILROAD MEDICARE PROVIDER PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1107401082 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1107401082 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4152744 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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