Organization
MACOMB INTERNAL MED CTR PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA RIVERA (OFFICE MANAGER)
(586) 751-5720
Entity
Organization
Contact information
Practice address
12296 12 MILE RD, WARREN, MI 48093
(586) 751-5720
(586) 751-2206
Mailing address
12296 12 MILE RD, WARREN, MI 48093
(586) 751-5720
(586) 751-2206
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP56670
MEDICARE PTAN
MI
Enumeration date
05/22/2007
Last updated
03/14/2013
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