1780791954 NPI number — KIM CECCANESE N.P.

Table of content: KIM CECCANESE N.P. (NPI 1780791954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780791954 NPI number — KIM CECCANESE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CECCANESE
Provider First Name:
KIM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONACEL
Provider Other First Name:
KIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780791954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1108
Provider Second Line Business Mailing Address:
ATTENTION: LYNDA THOMPSON
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-677-7400
Provider Business Mailing Address Fax Number:
734-677-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 BARCLAY CIR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-853-7270
Provider Business Practice Location Address Fax Number:
248-853-7230
Provider Enumeration Date:
08/24/2006

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: 363L00000X , with the licence number:  4704150130 , 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: 4292496 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5008666430 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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