Healthcare Provider Details

I. General information

NPI: 1467502252
Provider Name (Legal Business Name): MICHIGAN INTERNAL MEDICINE & PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 MILLER ROAD SUITE 5
SWARTZ CREEK MI
48473
US

IV. Provider business mailing address

9001 MILLER ROAD SUITE 5
SWARTZ CREEK MI
48473
US

V. Phone/Fax

Practice location:
  • Phone: 810-630-0404
  • Fax: 810-630-2306
Mailing address:
  • Phone: 810-630-0404
  • Fax: 810-630-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301072232
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301072232
License Number StateMI

VIII. Authorized Official

Name: DR. PUNAM SHARMAN
Title or Position: OWNER
Credential: M.D.
Phone: 810-630-0404