1528191723 NPI number — EDGARD ATEF BADINE MD

Table of content: SAULO J RIVERA AP (NPI 1427219021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528191723 NPI number — EDGARD ATEF BADINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADINE
Provider First Name:
EDGARD
Provider Middle Name:
ATEF
Provider Name Prefix Text:
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:
1528191723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54912-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-830-5900
Provider Business Mailing Address Fax Number:
920-738-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 N MEADE ST
Provider Second Line Business Practice Location Address:
SUITE W120
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54911-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-735-7300
Provider Business Practice Location Address Fax Number:
920-735-7333
Provider Enumeration Date:
03/14/2007

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: 207RH0003X , with the licence number:  MD 2007-0020 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 64179 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56388071 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800521089 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000Z2565 . This is a "MEDICAID GROUP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1932187044 . This is a "GROUP NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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