Healthcare Provider Details

I. General information

NPI: 1083793194
Provider Name (Legal Business Name): GENEMED INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S JOHNSON ST STE 1A
PONTIAC MI
48341-1658
US

IV. Provider business mailing address

35 S JOHNSON ST STE 1A
PONTIAC MI
48341-1658
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-4721
  • Fax: 248-334-3585
Mailing address:
  • Phone: 248-334-4721
  • Fax: 248-334-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS MATHEW
Title or Position: PRESIDENT
Credential: MD
Phone: 248-334-4721