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General NPI Number Information
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NPI Number | 1477861045
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Entity Type | Organization
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Legal Business Name | THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN LLC
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 05/17/2025
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Provider Practice Location Address
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Address Line | 6240 RASHELLE DR STE 101
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City | FLINT
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State | MI
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Zip | 48507-3938
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Country | US
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Telephone | 810-600-4000
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Fax | 810-600-4200
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Provider Business Mailing Address
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Address Line | 6240 RASHELLE DR STE 101
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City | FLINT
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State | MI
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Zip | 48507-3934
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Country | US
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Telephone | 810-600-4000
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Fax | 810-600-4200
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Authorized Official
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Title or Position | CEO
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Name | DEVIN LARSEN
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Credential |
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Telephone | 713-489-2198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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