1508143470 NPI number — PREFERRED HOSPITALISTS OF MICHIGAN

Table of content: (NPI 1508143470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508143470 NPI number — PREFERRED HOSPITALISTS OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HOSPITALISTS OF MICHIGAN
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:
1508143470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27450 SCHOENHERR RD
Provider Second Line Business Mailing Address:
500
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48088-6683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-582-7632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15855 19 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-630-3624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RIVARD
Authorized Official First Name:
CHERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC OFFICE COORDINATOR
Authorized Official Telephone Number:
586-582-7632

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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