Healthcare Provider Details

I. General information

NPI: 1053351551
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD
HOWELL MI
48843-1002
US

IV. Provider business mailing address

7305 E M 36 PO BOX 829
HAMBURG MI
48189-9715
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-6000
  • Fax:
Mailing address:
  • Phone: 810-231-2814
  • Fax: 810-231-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JAMES B. HAYNER
Title or Position: MEDICAL DIRECTOR INPATIENT SERVICES
Credential: M.D.
Phone: 810-231-2814