Basic Information
| Provider Information | |||||||||
| NPI: | 1356526602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE DISEASE CENTER OF MID-MICHIGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3937 PATIENT CARE DR. | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489114287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174852317 | ||||||||
| FaxNumber: | 5174851490 | ||||||||
| Practice Location | |||||||||
| Address1: | 3937 PATIENT CARE DR. | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489114287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174852317 | ||||||||
| FaxNumber: | 5174851490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | URVISH | ||||||||
| AuthorizedOfficialMiddleName: | KANTILAL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5174852317 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.