Healthcare Provider Details

I. General information

NPI: 1114118205
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF LUDINGTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N ATKINSON DR SUITE 111
LUDINGTON MI
49431-1953
US

IV. Provider business mailing address

7 N ATKINSON DR SUITE 111
LUDINGTON MI
49431-1953
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-3487
  • Fax: 231-843-1962
Mailing address:
  • Phone: 231-843-3487
  • Fax: 231-843-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number5101008322
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101008322
License Number StateMI

VIII. Authorized Official

Name: DR. RALPH AVEDISIAN
Title or Position: PRESIDENT
Credential: D. O., FACOI
Phone: 231-843-3487