1346332426 NPI number — MICHIGAN CORNEA CONSULTANTS PC

Table of content: (NPI 1346332426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346332426 NPI number — MICHIGAN CORNEA CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN CORNEA CONSULTANTS PC
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:
1346332426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29201 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-350-1130
Provider Business Mailing Address Fax Number:
248-350-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29201 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-350-1130
Provider Business Practice Location Address Fax Number:
248-350-2709
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBCHIK
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING COMPANY
Authorized Official Telephone Number:
734-207-1690

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180F319540 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3277575 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1818756 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1806325501 . This is a "STEVEN DUNN BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1806325521 . This is a "DAVID HEIDEMANN BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1806325541 . This is a "CHRISTOPHER CHOW BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1829787 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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