1760726384 NPI number — CHARNPREET SINGH PT

Table of content: CHARNPREET SINGH PT (NPI 1760726384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760726384 NPI number — CHARNPREET SINGH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGH
Provider First Name:
CHARNPREET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1760726384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7633 E JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48214-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-651-7170
Provider Business Mailing Address Fax Number:
313-824-2724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19785 W 12 MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 675
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-213-8294
Provider Business Practice Location Address Fax Number:
248-443-0165
Provider Enumeration Date:
11/20/2012

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: 225100000X , with the licence number:  5501016113 , 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: 0P12330 . This is a "MEDICARE GROUP PIN -IHG" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5501016113 . This is a "PT STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1760726384 . This is a "TYPE 1 NPI #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OH28276 . This is a "TYPE 2 BCBS PIN- IHG" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12476799 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OH70561 . This is a "TYPE 1 BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1144562083 . This is a "TYPE 2 NPI #- IHG PT GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010822105 . This is a "IHG TAX ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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