Provider Demographics
NPI:1114537818
Name:PREMIER INTEGRATIVE MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:PREMIER INTEGRATIVE MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:OJITEVWOBO
Authorized Official - Last Name:TOWEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-289-9782
Mailing Address - Street 1:18346 15 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9433
Mailing Address - Country:US
Mailing Address - Phone:313-289-9782
Mailing Address - Fax:269-789-9426
Practice Address - Street 1:391 S SHORE DR STE 213
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-224-6052
Practice Address - Fax:269-224-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty