Provider Demographics
NPI:1043785561
Name:DIGESTIVE HEALTH CLINIC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAMOON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELBEDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-908-9042
Mailing Address - Street 1:7214 ANDREA CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9655
Mailing Address - Country:US
Mailing Address - Phone:810-908-9042
Mailing Address - Fax:
Practice Address - Street 1:2486 NERREDIA ST STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4807
Practice Address - Country:US
Practice Address - Phone:810-720-1600
Practice Address - Fax:810-407-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty