Healthcare Provider Details

I. General information

NPI: 1265455299
Provider Name (Legal Business Name): OWOSSO INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK DR. SUITE 303
OWOSSO MI
48867
US

IV. Provider business mailing address

300 HEALTH PARK DR. SUITE 303
OWOSSO MI
48867
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-2299
  • Fax: 989-729-9109
Mailing address:
  • Phone: 989-723-2299
  • Fax: 989-729-9109

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: DR. DAVID J MOHLMAN
Title or Position: OWNER
Credential: D.O.
Phone: 989-723-2299