Individual
MIMA BACIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 E SHERMAN BLVD, MUSKEGON, MI 49444-1849
(231) 672-3883
Mailing address
PO BOX 1847, MUSKEGON, MI 49443-1847
(231) 727-4444
(231) 727-4451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301077001
MI
208M00000X
Hospitalist Physician
Primary
4301077001
MI
Other
Enumeration date
02/01/2006
Last updated
06/05/2017
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