Provider Demographics
NPI:1083704233
Name:EAST PARIS INTERNAL MEDICINE ASSOCIATES P.C
Entity Type:Organization
Organization Name:EAST PARIS INTERNAL MEDICINE ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-954-9260
Mailing Address - Street 1:1000 EAST PARIS AVE SE
Mailing Address - Street 2:STE 260
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-957-9237
Mailing Address - Fax:616-957-1013
Practice Address - Street 1:1000 EAST PARIS AVE. SE
Practice Address - Street 2:STE 260
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8313
Practice Address - Country:US
Practice Address - Phone:616-957-9237
Practice Address - Fax:616-957-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D16071Medicare UPIN