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1174740252 NPI number — MICHAEL WOODIN PHD

NPI Number: 1174740252
Health Care Provider/Practitioner: MICHAEL WOODIN PHD

Information about “1174740252” NPI (MICHAEL WOODIN PHD) exists in 1174740252 in HTML format HTML  |  1174740252 in plain Text format TXT  |  1174740252 in PDF (Portable Document Format) PDF  |  1174740252 in an XML format XML  formats.

NPI Number : 1174740252 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174740252",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOODIN",
    "FirstName": "MICHAEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1100 REID PARKWAY",
    "SecondLineMailingAddress": "MEDICAL STAFF SERVICES",
    "MailingAddressCityName": "RICHMOND",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47374",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "765-935-8802",
    "MailingAddressFaxNumber": "765-983-3219",
    "FirstLinePracticeLocationAddress": "1130 N J ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHMOND",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47374-1913",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "765-983-3298",
    "PracticeLocationAddressFaxNumber": "765-983-7970",
    "EnumerationDate": "04/19/2007",
    "LastUpdateDate": "09/27/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "20042068A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "P.07823",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TH0100X",
          "TaxonomyName": "Health Service Psychologist",
          "LicenseNumber": "20042068B",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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