1316232242 NPI number — MR. EDWARD A ANIAPAM BS., CADC

Table of content: MR. EDWARD A ANIAPAM BS., CADC (NPI 1316232242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316232242 NPI number — MR. EDWARD A ANIAPAM BS., CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANIAPAM
Provider First Name:
EDWARD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BS., CADC
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:
1316232242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 PINEVIEW DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-399-2563
Provider Business Mailing Address Fax Number:
313-894-7460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 COLLINGWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48206-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-305-7040
Provider Business Practice Location Address Fax Number:
313-894-7460
Provider Enumeration Date:
06/20/2011

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: 101YA0400X , with the licence number:  1-04689 , 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)





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