Organization
MIDWEST INTERNAL MEDICINE PLLC
Active
Other names
Midwest MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY LALANDE (ADMINISTRATOR)
(928) 453-8500
Entity
Organization
Contact information
Practice address
1840 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5771
(928) 453-8500
(928) 453-5556
Mailing address
1840 MESQUITE AVE, SUITE F, LAKE HAVASU CITY, AZ 86403-5771
(928) 453-8500
(928) 453-5556
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02092
RAILROAD MEDICARE
AZ
Enumeration date
07/02/2007
Last updated
04/20/2008
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