Healthcare Provider Details

I. General information

NPI: 1780706879
Provider Name (Legal Business Name): PCM MEDICAL SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N GRAND AVE
LANSING MI
48906-5160
US

IV. Provider business mailing address

PO BOX 67000 DEPT# 256801
DETROIT MI
48267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-7511
  • Fax: 517-485-7561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA COLEMAN-MIEZAN
Title or Position: OWNER
Credential: MD
Phone: 517-485-7511