1053351551 NPI number — INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC

Table of content: (NPI 1053351551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053351551 NPI number — INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1053351551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7305 E M 36
Provider Second Line Business Mailing Address:
PO BOX 829
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48189-9715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-231-2814
Provider Business Mailing Address Fax Number:
810-231-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 BYRON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-545-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
MEDICAL DIRECTOR INPATIENT SERVICES
Authorized Official Telephone Number:
810-231-2814

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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