Provider Demographics
NPI:1093861452
Name:CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE P C
Entity Type:Organization
Organization Name:CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARBUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-547-9100
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0112
Mailing Address - Country:US
Mailing Address - Phone:616-457-4919
Mailing Address - Fax:616-457-5261
Practice Address - Street 1:118 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1751
Practice Address - Country:US
Practice Address - Phone:248-547-9100
Practice Address - Fax:248-547-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010486452083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36448OtherBCBSM GRP PIN
MI0632359OtherBCBS IND PIN
MI0F36448OtherBCBSM GRP PIN
MIB45547Medicare UPIN