Provider Demographics
NPI:1972546372
Name:BABIN, DEREK J (MPT)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:J
Last Name:BABIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 W MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2645
Mailing Address - Country:US
Mailing Address - Phone:269-488-8360
Mailing Address - Fax:269-488-8359
Practice Address - Street 1:4613 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2645
Practice Address - Country:US
Practice Address - Phone:269-488-8360
Practice Address - Fax:269-488-8359
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
155812OtherGREAT LAKES HLTH PLN
7173604OtherAETNA GRP PIN
383148262OtherEIN-HEALTHCARE MIDWEST
383148262OtherEIN-HEALTHCARE MIDWEST
P92841Medicare UPIN
MICA3050Medicare PIN
MI0N74060001Medicare ID - Type Unspecified