Healthcare Provider Details

I. General information

NPI: 1093861452
Provider Name (Legal Business Name): CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N WASHINGTON AVE
ROYAL OAK MI
48067-1751
US

IV. Provider business mailing address

PO BOX 112
JENISON MI
49429-0112
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-9100
  • Fax: 248-547-9336
Mailing address:
  • Phone: 616-457-4919
  • Fax: 616-457-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number4301048645
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL R HARBUT
Title or Position: OWNER
Credential: M.D.
Phone: 248-547-9100