Provider Demographics
NPI:1114055811
Name:DOWNRIVER MEDICINE ASSOCIATES PLC
Entity Type:Organization
Organization Name:DOWNRIVER MEDICINE ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-782-3654
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-0127
Mailing Address - Country:US
Mailing Address - Phone:734-782-3654
Mailing Address - Fax:734-782-8947
Practice Address - Street 1:28747 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1544
Practice Address - Country:US
Practice Address - Phone:734-782-3654
Practice Address - Fax:734-782-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOL045607207R00000X
MIAD054293207R00000X
MI5601003734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H249500OtherBCBS GROUP NUMBER
MI=========OtherTAX ID
MI0M73900Medicare ID - Type UnspecifiedWANYE COUNTY
MI=========OtherTAX ID