MEDICARE: ALLEGAN INTERNAL 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110Z310760	OTHER	MI	BLUE CROSS PIN

General Provider Information

NPI Number	:	1508813114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGAN INTERNAL MEDICINE, P. C

Provider Business Mailing Address
First Line	:	305 THOMAS ST
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-9158
Country	:	US
Telephone Number	:	269-673-2179
Fax Number	:	269-673-6992

Provider Business Practice Location Address
First Line	:	305 THOMAS ST
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-9158
Country	:	US
Telephone Number	:	269-673-2179
Fax Number	:	269-673-6992

Authorized Official
Title or Position	:	OFFICE MANAGER/BILLING
Name	:	LAURIE L HILDEBRAND
Credential	:
Telephone Number	:	269-673-2179

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/22/2025

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