Provider Demographics
NPI:1003244120
Name:MID MICHIGAN GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MID MICHIGAN GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAMOON
Authorized Official - Middle Name:MAHGOUB
Authorized Official - Last Name:ELBEDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-6300
Mailing Address - Street 1:6240 RASHELLE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3935
Mailing Address - Country:US
Mailing Address - Phone:810-733-6300
Mailing Address - Fax:810-733-6344
Practice Address - Street 1:6240 RASHELLE DR STE 204
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3935
Practice Address - Country:US
Practice Address - Phone:810-733-6300
Practice Address - Fax:810-733-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104217207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty