1396898318 NPI number — DR. STUART LEE DONESON PH.D

Table of content: REBEKAH GRACE O'BRYAN (NPI 1396532735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396898318 NPI number — DR. STUART LEE DONESON PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONESON
Provider First Name:
STUART
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
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:
1396898318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4562 COMANCHE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-2064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-337-8447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4572 S HAGADORN RD STE 2H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-5385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-203-3300
Provider Business Practice Location Address Fax Number:
517-203-3300
Provider Enumeration Date:
01/21/2007

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: 103TC0700X , with the licence number:  6301 005005 , 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: 62 OC34603 . This is a "BLUECROSS BLUE SHIELD PIN" identifier . This identifiers is of the category "OTHER".




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