Active NPI
Angela K Paul, AU.D.
- Audiologist
- Detroit, MI
National Provider Identifier
1306934039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 1601000040
- Practice address
- 4646 John R St
Detroit, MI 48201-1916 - Phone
- (313) 576-1000
- Fax
- (586) 576-1092
- NPI assigned
- Oct 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000040 | MI | Primary |
Addresses
Primary practice location
4646 John R St
Detroit, MI 48201-1916
Mailing address
4646 John R St
Detroit, MI 48201-1916
Phone (313) 576-1000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0E01107 | Other | MI | BLUE SHIELD |
| 540E00292 | Other | MI | BLUE SHIELD |
| 640E07684 | Other | MI | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601000040 | MI | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeshore Ear Nose and Throat Center PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Otolaryngology Physician
- Saint Clair Shores, MI
- NPI 1033202023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1306934039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4646 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482011916",
"telephone_number": "313-576-1000",
"fax_number": "586-576-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482011916",
"telephone_number": "313-576-1000",
"fax_number": "586-576-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAUL",
"first_name": "ANGELA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MI",
"license": "1601000040",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "0E01107",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "540E00292",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "640E07684",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.