1821106584 NPI number — ASSOCIATED FOOT CLINIC OF LAKE ORION, P.C.

Table of content: (NPI 1821106584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821106584 NPI number — ASSOCIATED FOOT CLINIC OF LAKE ORION, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED FOOT CLINIC OF LAKE ORION, P.C.
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:
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:
1821106584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 N PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48362-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-693-8400
Provider Business Mailing Address Fax Number:
248-693-3970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 N PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ORION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48362-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-693-8400
Provider Business Practice Location Address Fax Number:
248-693-3970
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOROYAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-693-8400

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  JN001106 , 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: 1316950660 . This is a "PERSONAL NPI - J. NOROYAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1821106584 . This is a "GROUP NPI - AFC, PC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1659360212 . This is a "PERSONAL NPI - A. KALMUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1790702587 . This is a "PERSONAL NPI - G.CHRISTIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1793361 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480F373620 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245238153 . This is a "PERSONAL NPI - T. SNYDER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4N8635053 . This is a "L. O. H - J. NOROYAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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