1568630101 NPI number — MARGARET E GUSTAFSON MD PC

Table of content: MARGARET E. HODGSON MA LPC (NPI 1316109556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568630101 NPI number — MARGARET E GUSTAFSON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGARET E GUSTAFSON 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:
1568630101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 N ATKINSON DR
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
LUDINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49431-2918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-845-5992
Provider Business Mailing Address Fax Number:
231-843-1931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 N ATKINSON DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LUDINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49431-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-845-5992
Provider Business Practice Location Address Fax Number:
231-843-1931
Provider Enumeration Date:
02/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDE
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
231-845-5992

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MG040418 , 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: 2748496 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2097699 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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