Basic Information
| Provider Information | |||||||||
| NPI: | 1679663264 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERNAL MEDICINE ASSOCIATES OF SOUTHEAST MICHIGAN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5429 WHITTAKER ROAD | ||||||||
| Address2: | INTERNAL MEDICINE ASSOCIATES OF SOUTH EAST MICHIGAN | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344801400 | ||||||||
| FaxNumber: | 7344801456 | ||||||||
| Practice Location | |||||||||
| Address1: | 5429 WHITTAKER ROAD | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344801400 | ||||||||
| FaxNumber: | 7344801456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | MEKAI-VEKIMA | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | BALEMBA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7344801400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 4301070863 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 4471817 | 05 | MI | MEDICAID | 1679663264 | 01 | NPI | OTHER | P00282079 | 01 | MI | RAIL ROAD MEDICARE | OTHER | 4301070863 | 01 | MI | LICENSE | OTHER |