1912091562 NPI number — HURON VALLEY HEART, P.C.

Table of content: (NPI 1912091562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912091562 NPI number — HURON VALLEY HEART, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HURON VALLEY HEART, 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:
1912091562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 UNION ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48381-1989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-685-9780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 UNION ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48381-1989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-685-9780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KARABAJAKIAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-685-9780

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MK011367 , 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: P00061832 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0656310564 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F33901 . This is a "BCBS GROUP PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114578887 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com