Provider Demographics
NPI:1033426242
Name:DMC BILLING ASSOCIATES LLC
Entity Type:Organization
Organization Name:DMC BILLING ASSOCIATES LLC
Other - Org Name:HAGGARTY MEDICAL PLAZA
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-720-5715
Mailing Address - Street 1:PO BOX 673671
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:2050 N HAGGERTY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-259-0410
Practice Address - Fax:734-259-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P35120Medicare PIN