1356485189 NPI number — SUMET SILAPASWAN M D PC

Table of content: (NPI 1356485189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356485189 NPI number — SUMET SILAPASWAN M D PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMET SILAPASWAN M D 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:
1356485189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Mailing Address:
STE 504
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-559-5115
Provider Business Mailing Address Fax Number:
248-662-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
STE 504
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-559-5115
Provider Business Practice Location Address Fax Number:
248-662-3022
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SILAPASWAN
Authorized Official First Name:
SUMET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-559-5115

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  SS033649 , 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: A76666 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105432 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 316751 . This is a "PRORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 020F369850 . This is a "BCN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DQ2043 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 016655 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 020F369850 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 133835901 . This is a "UNITED HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7120511 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1356485189 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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