Provider Demographics
NPI:1114118205
Name:INTERNAL MEDICINE ASSOCIATES OF LUDINGTON, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF LUDINGTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AVEDISIAN
Authorized Official - Suffix:
Authorized Official - Credentials:D O, FACOI
Authorized Official - Phone:231-843-3487
Mailing Address - Street 1:7 N ATKINSON DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1953
Mailing Address - Country:US
Mailing Address - Phone:231-843-3487
Mailing Address - Fax:231-843-1962
Practice Address - Street 1:7 N ATKINSON DR
Practice Address - Street 2:SUITE 111
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1953
Practice Address - Country:US
Practice Address - Phone:231-843-3487
Practice Address - Fax:231-843-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008322207LC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2647582Medicaid
MI2647582Medicaid