1942206768 NPI number — DR. BRIAN MCCARDEL MD

Table of content: DR. BRIAN MCCARDEL MD (NPI 1942206768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942206768 NPI number — DR. BRIAN MCCARDEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARDEL
Provider First Name:
BRIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942206768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3394 E JOLLY RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48910-8595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-394-3200
Provider Business Mailing Address Fax Number:
517-394-4250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3394 E JOLLY RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-8595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-394-3200
Provider Business Practice Location Address Fax Number:
517-394-4250
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  4301055763 , 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: 200000001131 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0334204 . This is a "BLUECARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2003342042 . This is a "BLUE CROSS/BLUE SHILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3515597 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com