1396889416 NPI number — EUCLID MEDICAL GROUP P.C.

Table of content: DONNA WROBEL (NPI 1477259976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396889416 NPI number — EUCLID MEDICAL GROUP P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUCLID MEDICAL GROUP 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:
6
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:
1396889416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1458 W CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESSEXVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48732-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-895-4860
Provider Business Mailing Address Fax Number:
989-895-4870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1458 W CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESSEXVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48732-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-895-4860
Provider Business Practice Location Address Fax Number:
989-895-4870
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERNER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
989-892-7722

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LS011227 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01006518 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114982649 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007493 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114982630 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115176034 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700Z910470 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: JG007063 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P43930004 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010Z911030 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114983950 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: RK007099 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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