Provider Demographics
NPI:1043264906
Name:MID MICHIGAN GASTROINTESTINAL & MOTILITY PC
Entity Type:Organization
Organization Name:MID MICHIGAN GASTROINTESTINAL & MOTILITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARBABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-9098
Mailing Address - Street 1:3061 CHRISTY WAY
Mailing Address - Street 2:C/O PRO MED BILLING
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2267
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:
Practice Address - Street 1:4725 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2849
Practice Address - Country:US
Practice Address - Phone:989-799-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039002207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2093958Medicaid
MI0P43180Medicare PIN
MI2093958Medicaid