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1528252251

NPI Code Detail

MEDICARE: PORT HURON INTERNAL MEDICINE ASSOCIATES

MEDICARE: PORT HURON INTERNAL MEDICINE ASSOCIATES

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	4301076169	MI
2	207Q00000X	Family Medicine Physician	4301066771	MI
3	207R00000X	Internal Medicine Physician	4301095172	MI
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	4301061093	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DG3605	OTHER	MI	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0G41221	OTHER	MI	BCBSM
2	34108	OTHER	MI	HEALTH PLAN OF MICHIGAN

General Provider Information

NPI Number	:	1528252251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT HURON INTERNAL MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	2540 16TH ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6405
Country	:	US
Telephone Number	:	810-987-1000
Fax Number	:	810-982-1810

Provider Business Practice Location Address
First Line	:	2540 16TH ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6405
Country	:	US
Telephone Number	:	810-987-1000
Fax Number	:	810-982-1810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN I JARAD
Credential	:	M.D.
Telephone Number	:	810-987-1000

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	02/06/2015

Similar Medicare Providers

1245235654 — JOHN IMAD JARAD M.D.
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 810-987-1000
Practice Fax: 810-982-1810

1164423216 — CHERYL A CANTO M.D.
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 810-987-1000
Practice Fax: 810-982-1810

1326359993 — MS. ASHLEY MARIE RICHARDSON P.A.-C
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 810-987-1053
Practice Fax:

1154737609 — ANSHUM GOEL BHALLA M.D
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 810-987-1000
Practice Fax: 810-982-1810

1437609781 — PORT HURON INTERNAL MEDICINE
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 586-634-0055
Practice Fax:

1134761042 — KELLY THOMAS MSN, AGPCNP-C
Practice Location Address:

2540 16TH ST
PORT HURON, MI
48060-6405

Practice Phone: 810-987-1000
Practice Fax:

Directions to “PORT HURON INTERNAL MEDICINE ASSOCIATES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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