1326018524 NPI number — MICHELLE M SPRENGELMEYER MD

Table of content: MICHELLE M SPRENGELMEYER MD (NPI 1326018524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326018524 NPI number — MICHELLE M SPRENGELMEYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRENGELMEYER
Provider First Name:
MICHELLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1326018524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 LINCOLN RD
Provider Second Line Business Mailing Address:
SUITE L10
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722-4190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-355-9200
Provider Business Mailing Address Fax Number:
563-355-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S CODY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE CLAIRE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52753-9579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-421-9740
Provider Business Practice Location Address Fax Number:
563-421-9769
Provider Enumeration Date:
01/23/2006

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:  31003 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 036092392 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2137711 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036092392 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32228500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com