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NPI Code Detail

MEDICARE: PCM MEDICAL SERVICE PC

MEDICARE: PCM MEDICAL SERVICE PC
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1780706879
Entity Type Code : Organization
Provider Name (Legal Business Name) : PCM MEDICAL SERVICE PC
Provider Business Mailing Address
First Line : PO BOX 67000
Second Line : DEPT# 256801
City : DETROIT
State : MI
Zip : 48267-0002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 737 N GRAND AVE
Second Line :
City : LANSING
State : MI
Zip : 48906-5160
Country : US
Telephone Number : 517-485-7511
Fax Number : 517-485-7561
Authorized Official
Title or Position : OWNER
Name : PATRICIA COLEMAN-MIEZAN
Credential : MD
Telephone Number : 517-485-7511
Provider Enumeration Date : 04/06/2007
Last Update Date : 03/03/2014

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Directions to “PCM MEDICAL SERVICE PC ” Practice Location

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