1639496771 NPI number — MID MICHIGAN FERTILITY CARE

Table of content: (NPI 1639496771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639496771 NPI number — MID MICHIGAN FERTILITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID MICHIGAN FERTILITY CARE
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:
1639496771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
953 STROWBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48843-6623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 E MICHIGAN AVE STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-254-5772
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AWONUGA
Authorized Official First Name:
AWONIYI
Authorized Official Middle Name:
OLUMIDE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
347-254-5772

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  4301089357 , 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: 2683 NI , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com