MEDICARE: GREAT LAKES INTERNIST 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
1	261QP2300X	Primary Care Clinic/Center	4301065345	MI
2	207R00000X	Internal Medicine Physician	4301065345	MI

General Provider Information

NPI Number	:	1962555227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES INTERNIST PC

Provider Business Mailing Address
First Line	:	35000 DIVISION RD
Second Line	:	SUITE 9
City	:	RICHMOND
State	:	MI
Zip	:	48062-1566
Country	:	US
Telephone Number	:	586-727-7209
Fax Number	:	586-727-7929

Provider Business Practice Location Address
First Line	:	35000 DIVISION RD
Second Line	:	SUITE 9
City	:	RICHMOND
State	:	MI
Zip	:	48062-1566
Country	:	US
Telephone Number	:	586-228-8606
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOUHAMAD F RIHAWI
Credential	:	MD
Telephone Number	:	586-727-7209

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/02/2013

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Directions to “GREAT LAKES INTERNIST PC ” Practice Location

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