1679602361 NPI number — DR. DANIEL KEITH EHNIS EDD

Table of content: DR. DANIEL KEITH EHNIS EDD (NPI 1679602361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679602361 NPI number — DR. DANIEL KEITH EHNIS EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHNIS
Provider First Name:
DANIEL
Provider Middle Name:
KEITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD
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:
1679602361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4670 FULTON ST E
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49301-8455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-975-3160
Provider Business Mailing Address Fax Number:
616-975-3163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4670 FULTON ST E
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49301-8455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-975-3160
Provider Business Practice Location Address Fax Number:
616-975-3163
Provider Enumeration Date:
03/05/2007

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: 103T00000X , with the licence number:  6301006635 , 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)





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