Healthcare Provider Details

I. General information

NPI: 1992818207
Provider Name (Legal Business Name): PULMONARY CLINICS OF SOUTHERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE STE 105
JACKSON MI
49201
US

IV. Provider business mailing address

900 E MICHIGAN AVE STE 105
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-3190
  • Fax: 517-782-1223
Mailing address:
  • Phone: 517-782-3190
  • Fax: 517-782-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DON KNOX
Title or Position: ADMINISTRATOR
Credential:
Phone: 517-782-3190