1457563488 NPI number — MARIQUIT DUMAGUIN SENDELBACH D.O.

Table of content: MARIQUIT DUMAGUIN SENDELBACH D.O. (NPI 1457563488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457563488 NPI number — MARIQUIT DUMAGUIN SENDELBACH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENDELBACH
Provider First Name:
MARIQUIT
Provider Middle Name:
DUMAGUIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1457563488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23133 ORCHARD LAKE RD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48336-3268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-579-9220
Provider Business Mailing Address Fax Number:
248-426-7350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23133 ORCHARD LAKE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-471-8982
Provider Business Practice Location Address Fax Number:
248-471-9978
Provider Enumeration Date:
05/03/2007

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: 207RG0100X , with the licence number:  5101015783 , 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: 1457563488 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com