1508048018 NPI number — JAMES R GILSDORF MD PC

Table of content: (NPI 1508048018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508048018 NPI number — JAMES R GILSDORF MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R GILSDORF MD 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:
1508048018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 ARNET ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48198-5753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-483-0404
Provider Business Mailing Address Fax Number:
734-481-0844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ARNET ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48198-5753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-483-0404
Provider Business Practice Location Address Fax Number:
734-481-0844
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HACALA
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
248-457-9210

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  4301045438 , 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: B48642 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DC6914 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11276974 . This is a "CAQH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0004109376 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P101875 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1970536 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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