Provider Demographics
NPI:1205817863
Name:EMIG, MIMI (MD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:EMIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-774-2822
Mailing Address - Fax:
Practice Address - Street 1:230 MICHIGAN ST NE
Practice Address - Street 2:SUITE 230
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2550
Practice Address - Country:US
Practice Address - Phone:616-774-2822
Practice Address - Fax:616-391-8665
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073780207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110D148350 / 0410939OtherBCBSM
MI4900269Medicaid
MI4900269Medicaid
MIH03400Medicare UPIN