MEDICARE: MICHIGAN INTERNAL MEDICINE CENTER PC

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	4301075318	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1106304251	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1871777672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INTERNAL MEDICINE CENTER PC

Provider Business Mailing Address
First Line	:	928 BLOOMFIELD KNOLL DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-2015
Country	:	US
Telephone Number	:	248-761-5185
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 BLOOMFIELD KNOLL DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-2015
Country	:	US
Telephone Number	:	248-761-5185
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	KATHLEEN M NADAI
Credential	:
Telephone Number	:	248-547-3914

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	01/24/2018

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