1639259021 NPI number — DR. ADRIANNE MARIE CAMERO-SULAK PSY.D.

Table of content: DR. ADRIANNE MARIE CAMERO-SULAK PSY.D. (NPI 1639259021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639259021 NPI number — DR. ADRIANNE MARIE CAMERO-SULAK PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMERO-SULAK
Provider First Name:
ADRIANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
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:
1639259021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
376 OAK BROOK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48176-1579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-355-4439
Provider Business Mailing Address Fax Number:
734-429-9584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 E WILLIAM ST
Provider Second Line Business Practice Location Address:
SUITE 18-H
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48104-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-355-4439
Provider Business Practice Location Address Fax Number:
734-429-9584
Provider Enumeration Date:
10/17/2006

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: 103TC0700X , with the licence number:  6301011464 , 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: 795-8733 . This is a "AETNA PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 680H112680 . This is a "BCBS PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 133618 . This is a "PREFERRED CHOICES PPO PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 791860000 . This is a "MAGELLAN MIS NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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