1649419300 NPI number — TOTAL LOVING CARE & PODIATRIC SERVICES, P.C.

Table of content: (NPI 1649419300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649419300 NPI number — TOTAL LOVING CARE & PODIATRIC SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL LOVING CARE & PODIATRIC SERVICES, 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:
1649419300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1845
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48121-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-581-4325
Provider Business Mailing Address Fax Number:
313-582-4325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15324 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-581-4325
Provider Business Practice Location Address Fax Number:
313-582-4325
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOVING
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
LASHA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-581-4325

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  5901002009 , 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: 1992734727 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0H20551 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com