Basic Information
Provider Information | |||||||||
NPI: | 1528008885 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEUBECK | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1085 S LINDEN RD | ||||||||
Address2: | SUITE 150 | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 485323421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8107323240 | ||||||||
FaxNumber: | 8102300280 | ||||||||
Practice Location | |||||||||
Address1: | 1125 S LINDEN RD | ||||||||
Address2: | SUITE 900 | ||||||||
City: | FLINT | ||||||||
State: | MI | ||||||||
PostalCode: | 485324073 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8107337791 | ||||||||
FaxNumber: | 8107337898 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2006 | ||||||||
LastUpdateDate: | 01/17/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301031073 | MI | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | OM32030 | 01 | MI | MEDICARE GROUP | OTHER | 700B510700 | 01 | MI | BCBSM GROUP | OTHER |