# MACOMB INTERNAL MED CTR PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568671550
- **Authorized official:** MRS. GINA RIVERA (OFFICE MANAGER)
- **Authorized official phone:** (586) 751-5720

## Contact information

- **Practice address:** 12296 12 MILE RD, WARREN, MI 48093
- **Practice address phone:** (586) 751-5720
- **Practice address fax:** (586) 751-2206
- **Mailing address:** 12296 12 MILE RD, WARREN, MI 48093
- **Mailing address phone:** (586) 751-5720
- **Mailing address fax:** (586) 751-2206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 03/14/2013