1619027844 NPI number — JON STEFFEN NEWMAN PH.D.

Table of content: JON STEFFEN NEWMAN PH.D. (NPI 1619027844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619027844 NPI number — JON STEFFEN NEWMAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
JON
Provider Middle Name:
STEFFEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1619027844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
837 SEMINOLE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-6733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-780-0100
Provider Business Mailing Address Fax Number:
231-780-0111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 SEMINOLE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49441-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-780-0100
Provider Business Practice Location Address Fax Number:
231-780-0111
Provider Enumeration Date:
01/11/2007

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: 103G00000X , with the licence number:  6301013149 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301013149 , 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: P23730002 . This is a "WPS MEDICARE B" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 144318000 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 680F111610 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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