Healthcare Provider Details

I. General information

NPI: 1477861045
Provider Name (Legal Business Name): THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 RASHELLE DR STE 101
FLINT MI
48507-3938
US

IV. Provider business mailing address

6240 RASHELLE DR STE 101
FLINT MI
48507-3934
US

V. Phone/Fax

Practice location:
  • Phone: 810-600-4000
  • Fax: 810-600-4200
Mailing address:
  • Phone: 810-600-4000
  • Fax: 810-600-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DEVIN LARSEN
Title or Position: CEO
Credential:
Phone: 713-489-2198