1811171234 NPI number — CHRISTOPHER R DEANGELIS D.O

Table of content: (NPI 1811171234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811171234 NPI number — CHRISTOPHER R DEANGELIS D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER R DEANGELIS D.O
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:
1811171234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25000 HALL RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WOODHAVEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-676-3373
Provider Business Mailing Address Fax Number:
734-675-1678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25000 HALL RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-676-3373
Provider Business Practice Location Address Fax Number:
734-675-1678
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REIMAN
Authorized Official First Name:
SARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
734-676-3373

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  CD013396 , 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: 5390707 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P127746 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1158206834 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5820683 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C8111 . This is a "M CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110218318 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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