Healthcare Provider Details

I. General information

NPI: 1710980586
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF FLINT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G5607 W. BRISTOL RD.
FLINT MI
48507
US

IV. Provider business mailing address

3499 S LINDEN RD
FLINT MI
48507-3022
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-0120
  • Fax: 810-230-6733
Mailing address:
  • Phone: 810-230-0120
  • Fax: 810-230-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberEC023744
License Number StateMI

VIII. Authorized Official

Name: MRS. LEDEAN CHAMPINE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 810-230-0120