1487642575 NPI number — DR. STANLEY J CONHON MD

Table of content: DR. STANLEY J CONHON MD (NPI 1487642575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487642575 NPI number — DR. STANLEY J CONHON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONHON
Provider First Name:
STANLEY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
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:
1487642575
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:
401 S BALLENGER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-342-1000
Provider Business Mailing Address Fax Number:
810-342-1590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10090 E LIPPINCOTT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVISON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48423-9151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-658-1130
Provider Business Practice Location Address Fax Number:
810-658-8589
Provider Enumeration Date:
10/12/2005

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: 207Q00000X , with the licence number:  4301069918 , 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: 253092 . This is a "HEALTH ADVANTAGE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0988440 . This is a "HEALTH PLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: H17587 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4255705 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7738126 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C7601 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0802505252 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 253092 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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