Healthcare Provider Details

I. General information

NPI: 1902818230
Provider Name (Legal Business Name): MICHIGAN INTERNAL MEDICINE ASSOCIATES,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 W HURON ST
WATERFORD MI
48328-3730
US

IV. Provider business mailing address

1012 W HURON ST
WATERFORD MI
48328
US

V. Phone/Fax

Practice location:
  • Phone: 248-681-1880
  • Fax: 248-681-3698
Mailing address:
  • Phone: 248-681-1880
  • Fax: 248-681-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. ANDREW ZAZAIAN
Title or Position: PHYSICIAN PRESIDENT
Credential: DO
Phone: 248-681-1880