Organization
MODULEMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PITTMAN (GENERAL MANAGER, CREDENTIALING)
(810) 214-0437
Entity
Organization
Contact information
Practice address
8359 OFFICE PARK DR, GRAND BLANC, MI 48439-2078
(877) 347-7978
Mailing address
8359 OFFICE PARK DR, GRAND BLANC, MI 48439-2078
(877) 347-7978
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Enumeration date
11/07/2025
Last updated
11/07/2025
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