1427537646 NPI number — MS. JUDIYE EVA BERKAN-WILLIAMS OTR

Table of content: MS. JUDIYE EVA BERKAN-WILLIAMS OTR (NPI 1427537646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427537646 NPI number — MS. JUDIYE EVA BERKAN-WILLIAMS OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERKAN-WILLIAMS
Provider First Name:
JUDIYE
Provider Middle Name:
EVA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

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:
1427537646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7150 GRANITE CIRCLE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-297-1194
Provider Business Mailing Address Fax Number:
419-843-4158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 EAST CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-772-9191
Provider Business Practice Location Address Fax Number:
616-772-1459
Provider Enumeration Date:
08/08/2018

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: 225X00000X , with the licence number:  5201002989 , 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)





Copyright © 2007-2025 www.npivalidator.com