Provider Demographics
NPI:1043414337
Name:MICHAEL J SLAVIN M D PC
Entity Type:Organization
Organization Name:MICHAEL J SLAVIN M D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-792-8683
Mailing Address - Street 1:835 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5782
Mailing Address - Country:US
Mailing Address - Phone:989-792-8683
Mailing Address - Fax:989-792-1090
Practice Address - Street 1:835 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5782
Practice Address - Country:US
Practice Address - Phone:989-792-8683
Practice Address - Fax:989-792-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI036552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45564Medicare UPIN