1346225687 NPI number — RICHARD A LEZOTTE D.C.

Table of content: RICHARD A LEZOTTE D.C. (NPI 1346225687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346225687 NPI number — RICHARD A LEZOTTE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEZOTTE
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1346225687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 COMMERCE PARK DR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
DEWITT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48820-7967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-668-1300
Provider Business Mailing Address Fax Number:
517-669-7227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 COMMERCE PARK DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DEWITT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48820-7967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-668-1300
Provider Business Practice Location Address Fax Number:
517-669-7227
Provider Enumeration Date:
12/09/2005

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: 111N00000X , with the licence number:  2301008037 , 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: 4400042 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950A950100 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com