Provider Demographics
NPI:1124179924
Name:DIGESTIVE DISEASE CONSULTANTS, PC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-858-3878
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3878
Mailing Address - Fax:248-209-6777
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3878
Practice Address - Fax:248-209-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100F316670OtherBLUE CROSS BLUE SHEILD
MI0M93770Medicare ID - Type Unspecified