MEDICARE: SOUTHEAST INTERNAL MEDICINE PLLC

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	207R00000X	Internal Medicine Physician	5101012342	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326046418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	29159 HELMAN
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48183-0172
Country	:	US
Telephone Number	:	734-671-5100
Fax Number	:	734-671-7664

Provider Business Practice Location Address
First Line	:	29159 HELMAN BLVD
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48183
Country	:	US
Telephone Number	:	734-671-5100
Fax Number	:	734-671-7664

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. MARGARET MCQUISTON
Credential	:	DO
Telephone Number	:	734-671-5100

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/16/2007

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Directions to “SOUTHEAST INTERNAL MEDICINE PLLC ” Practice Location

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