1972673200 NPI number — MRS. KARIN EMILIE STOCKMANN MORTENSEN DDS

Table of content: MRS. KARIN EMILIE STOCKMANN MORTENSEN DDS (NPI 1972673200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972673200 NPI number — MRS. KARIN EMILIE STOCKMANN MORTENSEN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKMANN MORTENSEN
Provider First Name:
KARIN
Provider Middle Name:
EMILIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1972673200
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:
1425 N MCLEAN BLVD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-695-4188
Provider Business Mailing Address Fax Number:
847-695-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 N MCLEAN BLVD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-695-4188
Provider Business Practice Location Address Fax Number:
847-695-0650
Provider Enumeration Date:
11/08/2006

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: 1223P0300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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