1730136672 NPI number — ADINA-MARIA ANDERSON DPM

Table of content: ADINA-MARIA ANDERSON DPM (NPI 1730136672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730136672 NPI number — ADINA-MARIA ANDERSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
ADINA-MARIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1730136672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRON MOUNTAIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49801-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-774-1313
Provider Business Mailing Address Fax Number:
906-776-5639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 W H ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRON MOUNTAIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49801-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-776-5940
Provider Business Practice Location Address Fax Number:
906-779-2586
Provider Enumeration Date:
05/27/2006

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: 213E00000X , with the licence number:  5901002125 , 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: 43241400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5220021 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4881074 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00958672 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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