1306989199 NPI number — DR. ARMAND. MICHAEL MARASCO DPM

Table of content: DR. ARMAND. MICHAEL MARASCO DPM (NPI 1306989199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306989199 NPI number — DR. ARMAND. MICHAEL MARASCO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARASCO
Provider First Name:
ARMAND.
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
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:
1306989199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 E 86TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-3381
Provider Business Mailing Address Fax Number:
219-769-3880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 E 86TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-769-3381
Provider Business Practice Location Address Fax Number:
219-769-3880
Provider Enumeration Date:
02/14/2007

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: 213ES0103X , with the licence number:  07000376 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61100073 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000084011 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0805140001 . This is a "DME SUPPLIER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100142220-A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com