Provider Demographics
NPI:1124011127
Name:INTERNAL MEDICINE CLINIC PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:METZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-3485
Mailing Address - Street 1:105 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1301
Mailing Address - Country:US
Mailing Address - Phone:989-356-3485
Mailing Address - Fax:989-356-6396
Practice Address - Street 1:105 ARBOR LN
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1301
Practice Address - Country:US
Practice Address - Phone:989-356-3485
Practice Address - Fax:989-356-6396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHS024997207R00000X
MIMC034224207RE0101X
MIJM059074207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID
MI=========OtherTAX ID