Provider Demographics
NPI:1578586921
Name:ESPINOZA, SALVADOR (MD)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-382-2500
Mailing Address - Fax:269-373-0123
Practice Address - Street 1:200 N PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3731
Practice Address - Country:US
Practice Address - Phone:269-382-2500
Practice Address - Fax:269-373-0123
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI320A111090OtherBCBS GROUP NUMBER
MI104780939Medicaid
MI1588778484OtherBCBSM - WMU
MI1578586921Medicaid
MI3835921220OtherTAX ID
MIN66670011 - WMUMedicare PIN
MIN30570003Medicare ID - Type Unspecified
MI104780939Medicaid