1700885142 NPI number — MICHAEL W SOEHNLEN MD

Table of content: MICHAEL W SOEHNLEN MD (NPI 1700885142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700885142 NPI number — MICHAEL W SOEHNLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOEHNLEN
Provider First Name:
MICHAEL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700885142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 72384
Provider Second Line Business Mailing Address:
RADIOLOGY ASSOCIATES OF CANTON, INC.
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-686-1837
Provider Business Mailing Address Fax Number:
330-686-5928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 6TH ST SW
Provider Second Line Business Practice Location Address:
RADIOLOGY ASSOCIATES OF CANTON, INC.
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-363-2842
Provider Business Practice Location Address Fax Number:
330-580-5536
Provider Enumeration Date:
07/19/2005

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: 2085R0202X , with the licence number:  MD421874 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: 35 087482 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35087482 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X , with the licence number: 35087482 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00971839 . This is a "RXR MCR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2636875 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100160410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221126200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00407450 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".