1376540369 NPI number — NOSSONAL KLEINFELDT MD

Table of content: NOSSONAL KLEINFELDT MD (NPI 1376540369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376540369 NPI number — NOSSONAL KLEINFELDT MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEINFELDT
Provider Other First Name:
NATE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376540369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30150 TELEGRAPH RD STE 271
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BINGHAM FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-4521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-395-5175
Provider Business Mailing Address Fax Number:
248-395-5170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33400 6 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-421-2020
Provider Business Practice Location Address Fax Number:
734-421-2020
Provider Enumeration Date:
07/05/2005

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:  4301072297 , 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: 382155439 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180H27019 . This is a "BLUE CARE NETWORK HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104485008 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180H27019 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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