MEDICARE: PALLIATIVE MEDICINE ASSOCIATES 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	2084H0002X	Hospice and Palliative Medicine (Psychiatry & Neurology) Physician	4301045058	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1154306355	OTHER	MI	NPI (INDIVIDUAL PROVIDER)
2	4301045058	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1346508306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE MEDICINE ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	2346 S COMMERCE RD
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-2126
Country	:	US
Telephone Number	:	810-923-4485
Fax Number	:	248-849-2834

Provider Business Practice Location Address
First Line	:	2346 S COMMERCE RD
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-2126
Country	:	US
Telephone Number	:	810-923-4485
Fax Number	:	248-849-2834

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN W FINN
Credential	:	MD
Telephone Number	:	810-923-4485

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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