1336349547 NPI number — ANTHONY TRIVINO HSU D.O.

Table of content: ANTHONY TRIVINO HSU D.O. (NPI 1336349547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336349547 NPI number — ANTHONY TRIVINO HSU D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HSU
Provider First Name:
ANTHONY
Provider Middle Name:
TRIVINO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1336349547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY STE 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-697-2822
Provider Business Mailing Address Fax Number:
888-443-3187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-697-2822
Provider Business Practice Location Address Fax Number:
888-443-3187
Provider Enumeration Date:
07/25/2007

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: 207W00000X , with the licence number:  5101017422 , 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: 1336349547 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000033173 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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