Provider Demographics
NPI:1043367824
Name:INTERNAL MEDICINE ASSOCIATES OF ADRIAN PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF ADRIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-263-2187
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-0747
Mailing Address - Country:US
Mailing Address - Phone:517-263-2187
Mailing Address - Fax:517-263-0024
Practice Address - Street 1:781 LAKESHIRE TRL
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1561
Practice Address - Country:US
Practice Address - Phone:517-263-2187
Practice Address - Fax:517-263-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28960Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER