# IMG MEDICAL GROUP MI, P.C.

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

## Provider details

- **NPI number:** 1578308862
- **Authorized official:** KELSI SULLIVAN PA-C (VP CLINICAL SERVICES)
- **Authorized official phone:** (888) 760-4266

## Contact information

- **Practice address:** 201 BROAD ST STE 420, STAMFORD, CT 06901-2004
- **Practice address phone:** (888) 760-4266
- **Mailing address:** 201 BROAD ST STE 420, STAMFORD, CT 06901-2004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2024
- **Last updated:** 06/28/2024