1316082050 NPI number — CHRISTOPHER J ORAVITZ M.D.

Table of content: CHRISTOPHER J ORAVITZ M.D. (NPI 1316082050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316082050 NPI number — CHRISTOPHER J ORAVITZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORAVITZ
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
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:
1316082050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 E M 55
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAWAS CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48763-9362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-362-2540
Provider Business Mailing Address Fax Number:
989-362-7290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 E M 55
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAWAS CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48763-9362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-362-2540
Provider Business Practice Location Address Fax Number:
989-362-7290
Provider Enumeration Date:
02/20/2007

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: 207V00000X , with the licence number:  CO060262 , 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: 160049787 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 14493 . This is a "GREAT LAKES HEALTH PLAN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000070 . This is a "CAPE HEALTH PLAN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006413 . This is a "MCLAREN HEALTH PLAN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C39880 . This is a "MCARE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104201400 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383516078 . This is a "TAX ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1607367690 . This is a "BCBS #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 95C00857 . This is a "HEALTHPLUS #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 17917 . This is a "COMMUNITY CHOICE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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