1265438790 NPI number — DR. PETER W SPRINGSTEEN M.D.

Table of content: DR. PETER W SPRINGSTEEN M.D. (NPI 1265438790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265438790 NPI number — DR. PETER W SPRINGSTEEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRINGSTEEN
Provider First Name:
PETER
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
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:
1265438790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3074 N US 31 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-4533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-929-1234
Provider Business Mailing Address Fax Number:
231-935-0984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3074 N US 31 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-929-1234
Provider Business Practice Location Address Fax Number:
231-935-0984
Provider Enumeration Date:
06/21/2005

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: 207Q00000X , with the licence number:  4301046107 , 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: 383530686 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1265438790 . This is a "PETER SPRINGSTEEN MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 121593 . This is a "UNITED HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 349386200 . This is a "US POSTAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700B810660 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B45155 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38353068651 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 132959 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000010478 . This is a "CAP HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080181251 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080B810330 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1851344964 . This is a "URGENT CARE OF TRAVERSE CITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4391565 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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