1538269675 NPI number — MALIN ELISABETH ASEBY-GESCH D.C.

Table of content: MALIN ELISABETH ASEBY-GESCH D.C. (NPI 1538269675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538269675 NPI number — MALIN ELISABETH ASEBY-GESCH D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASEBY-GESCH
Provider First Name:
MALIN
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1538269675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND MARAIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-387-2383
Provider Business Mailing Address Fax Number:
218-387-2383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND MARAIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55604-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-387-2383
Provider Business Practice Location Address Fax Number:
218-387-2383
Provider Enumeration Date:
09/25/2006

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: 111N00000X , with the licence number:  3267 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29G38SA . This is a "BC/BS OF MN GRP#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3570193-00 . This is a "MINNESOTA CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 29G39GE . This is a "BC/BS OF MN INDIVIDUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 350051297 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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