1316182777 NPI number — DEARBORN MEDICAL ASSOCIATES, P.C.

Table of content: AMANDA LOUISE WHORTON (NPI 1609342468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316182777 NPI number — DEARBORN MEDICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARBORN MEDICAL ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316182777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 250704
Provider Second Line Business Mailing Address:
6725 DALY RD.
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48325-0704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-788-7706
Provider Business Mailing Address Fax Number:
248-788-0276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19855 WEST OUTER DR.
Provider Second Line Business Practice Location Address:
SUITE L7
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-277-4929
Provider Business Practice Location Address Fax Number:
313-561-1842
Provider Enumeration Date:
12/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STUDZINSKI
Authorized Official First Name:
URSZULA
Authorized Official Middle Name:
ANNA
Authorized Official Title or Position:
M.D. / OWNER
Authorized Official Telephone Number:
313-277-4929

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  4301062467 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 4301062467 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301062467 , 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: 136372 . This is a "CARE CHOICES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3355617 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OM13040 . This is a "MEDCARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0824714 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37725 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "SELECTCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00197310 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 923-1 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000001 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000001 . This is a "MEDICARE BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "FEDERAL BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 136372 . This is a "CARE CHOICES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "BLUE CARE NETWORK OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12052 . This is a "CAPE HEALTHPLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DR82155 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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