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Organization

MACOMB INTERNAL MEDICINE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY GUNST (OFFICE MANAGER)
(586) 228-1010
Entity
Organization

Contact information

Practice address
15520 19 MILE RD, SUITE 480, CLINTON TWP, MI 48038-6333
(586) 228-1010
(586) 228-8570
Mailing address
15520 19 MILE RD, SUITE 480, CLINTON TWP, MI 48038-6333
(586) 228-1010
(586) 228-8570

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207RN0300X
Nephrology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110E07884
BLUE CROSS BLUE SHIELD MI
MI
05
1639266885
MI
Enumeration date
10/09/2006
Last updated
04/18/2022
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