1487816419 NPI number — ADVANCED PULMONARY & SLEEP ASSOCIATES PC

Table of content: (NPI 1487816419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487816419 NPI number — ADVANCED PULMONARY & SLEEP ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PULMONARY & SLEEP ASSOCIATES PC
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:
1487816419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 N TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48128-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-294-5400
Provider Business Mailing Address Fax Number:
313-294-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 N TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-294-5400
Provider Business Practice Location Address Fax Number:
313-294-5401
Provider Enumeration Date:
07/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEEBAJAH
Authorized Official First Name:
IHAB
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-333-6733

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  4301067420 , 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: 290H242810 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 82027712 . This is a "PROCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1109501061 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DN8728 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 026029 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1109500421 . This is a "BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1109500421 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1109501061 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 290H242810 . This is a "BCN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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