MEDICARE: PRIME INTERNISTS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1174031298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME INTERNISTS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3272
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48605-3272
Country	:	US
Telephone Number	:	989-797-1400
Fax Number	:	989-797-4077

Provider Business Practice Location Address
First Line	:	3175 CHRISTY WAY S STE 8
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-2210
Country	:	US
Telephone Number	:	989-401-7000
Fax Number	:	989-401-7325

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	GHAZANFAR LATIF
Credential	:	MD
Telephone Number	:	609-576-6322

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/16/2018

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