Basic Information
Provider Information | |||||||||
NPI: | 1841288693 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PINNELL | ||||||||
FirstName: | GREGORY | ||||||||
MiddleName: | ARTHUR | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 LAPEER AVE | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486071208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897596464 | ||||||||
FaxNumber: | 9893998233 | ||||||||
Practice Location | |||||||||
Address1: | 1522 JANES ST | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486011819 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897550316 | ||||||||
FaxNumber: | 9897550956 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 04/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301075483 | MI | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0090252 | 01 | MI | BCBS PIN | OTHER | 116165 | 01 |   | GREAT LAKES HEALTH PLAN | OTHER | 264 | 01 | MI | COMMUNITY CHOICE | OTHER | 381908328 | 01 |   | TRICARE | OTHER | 160050643 | 01 |   | RAILROAD MEDICARE | OTHER | 381908328 | 01 |   | FIRST HEALTH | OTHER | 0800902521 | 01 | MI | BCBS PIN | OTHER | 080G310660 | 01 | MI | BCBS | OTHER | 1010673 | 01 |   | HEALTH ADVANTAGE PPO | OTHER | 381908328 | 01 |   | PPOM | OTHER | 4686730 | 01 | MI | MOLINA HEALTH CARE | OTHER | 1010673 | 01 |   | MCLAREN HEALTH PLAN | OTHER | 0988680 | 01 | MI | HEALTHPLUS | OTHER | 7323200 | 01 |   | AETNA | OTHER | 381908328 | 01 |   | HCAP | OTHER | P109042 | 01 | MI | BLUE CARE NETWORK | OTHER |