1881883791 NPI number — MR. RICARTHUR DANO LONTOC PT

Table of content: MR. RICARTHUR DANO LONTOC PT (NPI 1881883791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881883791 NPI number — MR. RICARTHUR DANO LONTOC PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONTOC
Provider First Name:
RICARTHUR
Provider Middle Name:
DANO
Provider Name Prefix Text:
MR.
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:
1881883791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTON HARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49023-8704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-925-9491
Provider Business Mailing Address Fax Number:
269-925-9553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 PIPESTONE RD
Provider Second Line Business Practice Location Address:
STE. 202A
Provider Business Practice Location Address City Name:
BENTON HARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49022-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-925-9491
Provider Business Practice Location Address Fax Number:
269-925-9553
Provider Enumeration Date:
10/16/2007

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:  5501004651 , 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: 39028 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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