Healthcare Provider Details

I. General information

NPI: 1326046418
Provider Name (Legal Business Name): SOUTHEAST INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29159 HELMAN BLVD
BROWNSTOWN MI
48183
US

IV. Provider business mailing address

29159 HELMAN
BROWNSTOWN MI
48183-0172
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-5100
  • Fax: 734-671-7664
Mailing address:
  • Phone: 734-671-5100
  • Fax: 734-671-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101012342
License Number StateMI

VIII. Authorized Official

Name: DR. MARGARET MCQUISTON
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 734-671-5100