1588631147 NPI number — ANNEMARIE LINDA DALY M.D.

Table of content: ANNEMARIE LINDA DALY M.D. (NPI 1588631147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588631147 NPI number — ANNEMARIE LINDA DALY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALY
Provider First Name:
ANNEMARIE
Provider Middle Name:
LINDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINARES
Provider Other First Name:
ANNEMARIE
Provider Other Middle Name:
LINDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588631147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6600
Provider Business Mailing Address Fax Number:
855-618-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 KIRTS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-824-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2006

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: 207R00000X , with the licence number:  AD054293 , 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: 4522040 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700E811600 . This is a "BCBS GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700H249500 . This is a "BCBS GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CG3568 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 060057218 . This is a "RAILROAD MEDICARE ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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