Provider Demographics
NPI:1962635169
Name:ALLEN SILBERGLEIT MD PC
Entity Type:Organization
Organization Name:ALLEN SILBERGLEIT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBERGLEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-6433
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-335-6433
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-335-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962635169OtherNPI GROUP
MI1992871255OtherNPI
MI2025448Medicaid
3306380811OtherBLUE CROSS BLUE SHIELD
MI1992871255OtherNPI
MI2025448Medicaid
2639583Medicare PIN