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General NPI Number Information
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NPI Number | 1104991207
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 1005 W GREEN ST SUITE 301
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City | HASTINGS
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State | MI
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Zip | 49058-1712
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Country | US
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Telephone | 269-945-2419
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Fax | 269-945-0357
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Provider Business Mailing Address
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Address Line | 1005 W GREEN ST SUITE 301
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City | HASTINGS
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State | MI
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Zip | 49058-1712
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Country | US
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Telephone | 269-945-2419
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Fax | 269-945-0357
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN GEORGE WILDERN
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Credential | M.D.
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Telephone | 269-945-2419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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