MEDICARE: CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	4301048645	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F36448	OTHER	MI	BCBSM GRP PIN
2	0632359	OTHER	MI	BCBS IND PIN

General Provider Information

NPI Number	:	1093861452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE P C

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49429-0112
Country	:	US
Telephone Number	:	616-457-4919
Fax Number	:	616-457-5261

Provider Business Practice Location Address
First Line	:	118 N WASHINGTON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1751
Country	:	US
Telephone Number	:	248-547-9100
Fax Number	:	248-547-9336

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL R HARBUT
Credential	:	M.D.
Telephone Number	:	248-547-9100

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	02/03/2010

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