NPI |
1609388701 |
The first name of the authorized official. |
Entity Type Code |
1 |
The middle name of the authorized official. |
Provider Last Name Legal Name |
DAVIS |
The title or position of the authorized official. |
Provider First Name |
CHRISTINA |
The 10-position telephone number of the authorized official. |
Provider First Line Business Practice Location Address |
41521 W 11 MILE RD |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address City Name |
NOVI |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MI |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
483751803 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2482990030 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Provider Enumeration Date |
10/30/2017 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/30/2017 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
106S00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |