1649742834 NPI number — THOMAS R PERKINS DO PLC

Table of content: (NPI 1649742834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649742834 NPI number — THOMAS R PERKINS DO PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS R PERKINS DO PLC
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:
1649742834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1349 S ROCHESTER RD STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-3152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-239-5300
Provider Business Mailing Address Fax Number:
248-239-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1349 S ROCHESTER RD STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-239-5300
Provider Business Practice Location Address Fax Number:
248-239-5305
Provider Enumeration Date:
12/28/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLER/MANAGER
Authorized Official Telephone Number:
248-239-5300

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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