1598765141 NPI number — DR. KRISTI SCHONS D.P.M.

Table of content: RICHARD EVANS BRUNER DO (NPI 1780684332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598765141 NPI number — DR. KRISTI SCHONS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHONS
Provider First Name:
KRISTI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1598765141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1251 S LAPEER RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48360-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-693-7700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 230B
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-855-3232
Provider Business Practice Location Address Fax Number:
248-855-3338
Provider Enumeration Date:
07/26/2005

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: 213E00000X , with the licence number:  KS001995 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X , with the licence number: KS001995 , 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: 13 4782030 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4429090 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00284860 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 137001 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480E01215 . This is a "BLUE CROSS/BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 13 4777245 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00303948 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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