1730201104 NPI number — CATHERINE MCAULEY HEALTH SERVICES

Table of content: ROBIE RENATO STERLING MD (NPI 1710282199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730201104 NPI number — CATHERINE MCAULEY HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHERINE MCAULEY HEALTH SERVICES
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:
1730201104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2691 RELIABLE PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60686-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 S INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SALINE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48176-9175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-429-8688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAJA
Authorized Official First Name:
GARRY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
734-975-4101

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110H110540 . This is a "BCBS BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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