Basic Information
| Provider Information | |||||||||
| NPI: | 1699719716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY,PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7305 E M 36 | ||||||||
| Address2: | PO BOX 829 | ||||||||
| City: | HAMBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102312814 | ||||||||
| FaxNumber: | 8102316080 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 E HURON RIVER DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAYNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR INPATIENT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8102312814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.