MEDICARE: BAY VALLEY INTERNAL MEDICINE 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	:	1598876252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY VALLEY INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	4818 W PROFESSIONAL DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2844
Country	:	US
Telephone Number	:	989-686-8100
Fax Number	:	989-686-8109

Provider Business Practice Location Address
First Line	:	4818 W PROFESSIONAL DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2844
Country	:	US
Telephone Number	:	989-686-8100
Fax Number	:	989-686-8109

Authorized Official
Title or Position	:	BILLING
Name	:	FRAN SKELTIS
Credential	:
Telephone Number	:	989-686-8100

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/08/2007

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