1649355801 NPI number — CYNTHIA R AKS DO PC

Table of content: (NPI 1649355801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649355801 NPI number — CYNTHIA R AKS DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA R AKS DO PC
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:
6
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:
1649355801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13383 REECK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHGATE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48195-3054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-285-8144
Provider Business Mailing Address Fax Number:
734-285-8104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13383 REECK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHGATE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48195-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-285-8144
Provider Business Practice Location Address Fax Number:
734-285-8104
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AKS
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-285-8144

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  CA009351 , 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: 134360 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0258213724 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 14797 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 020044482 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4124481 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020H232520 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E83433 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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