1376964411 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS, P.C.

Table of content: (NPI 1376964411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376964411 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN HEALTHCARE PROFESSIONALS, P.C.
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:
1376964411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29992 NORTHWESTERN HWY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-3292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-851-1430
Provider Business Mailing Address Fax Number:
248-851-5182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32255 NORTHWESTERN HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-1566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-647-1100
Provider Business Practice Location Address Fax Number:
248-945-1819
Provider Enumeration Date:
12/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARGOLIS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-851-2446

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540H712140 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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