Basic Information
Provider Information | |||||||||
NPI: | 1689667644 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEV | ||||||||
FirstName: | SANTOSH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2121 HUGHES DR | ||||||||
Address2: | SUITE 300 | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436063845 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192912121 | ||||||||
FaxNumber: | 4194796017 | ||||||||
Practice Location | |||||||||
Address1: | 2121 HUGHES DR | ||||||||
Address2: | SUITE 300 | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436063845 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192912121 | ||||||||
FaxNumber: | 4194796017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/25/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35042435 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 0633284 | 01 | OH | AETNA | OTHER | 10720 | 01 | OH | HPM | OTHER | 12-03670 | 01 | MI | UHC | OTHER | 3505802291 | 01 | MI | BCBS MI | OTHER | 000000240862 | 01 | MI | ANTHEM | OTHER | 000000141234 | 01 | OH | ANTHEM | OTHER | 00009 | 01 | OH | PHC | OTHER | 12-01286 | 01 | OH | UHC | OTHER | 400386 | 01 | MI | AETNA | OTHER | 0438619 | 01 | OH | BCMH | OTHER | 0438619 | 05 | OH |   | MEDICAID |