1669408613 NPI number — JEFFREY L BELKIN M.D.

Table of content: JEFFREY L BELKIN M.D. (NPI 1669408613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669408613 NPI number — JEFFREY L BELKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELKIN
Provider First Name:
JEFFREY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1669408613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30123 HIGH VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-2169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-318-6898
Provider Business Mailing Address Fax Number:
279-365-0233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29877 TELEGRAPH ROAD
Provider Second Line Business Practice Location Address:
STE L-12
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-7657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-213-6222
Provider Business Practice Location Address Fax Number:
279-365-0233
Provider Enumeration Date:
06/23/2006

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: 207L00000X , with the licence number:  4301039946 , 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)