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General NPI Number Information
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NPI Number | 1902818230
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Entity Type | Organization
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Legal Business Name | MICHIGAN INTERNAL MEDICINE ASSOCIATES,P.C.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1012 W HURON ST
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City | WATERFORD
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State | MI
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Zip | 48328-3730
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Country | US
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Telephone | 248-681-1880
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Fax | 248-681-3698
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Provider Business Mailing Address
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Address Line | 1012 W HURON ST
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City | WATERFORD
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State | MI
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Zip | 48328
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Country | US
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Telephone | 248-681-1880
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Fax | 248-681-3698
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. ANDREW ZAZAIAN
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Credential | DO
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Telephone | 248-681-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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