Provider Demographics
NPI:1225104011
Name:DIGESTIVE HEALTH ASSOCIATES OF NORTHERN MICHIGAN, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH ASSOCIATES OF NORTHERN MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMINHIZER
Authorized Official - Suffix:
Authorized Official - Credentials:CMM, MA
Authorized Official - Phone:231-935-9060
Mailing Address - Street 1:4100 PARK FOREST DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7331
Mailing Address - Country:US
Mailing Address - Phone:231-935-5710
Mailing Address - Fax:231-935-9045
Practice Address - Street 1:4100 PARK FOREST DR
Practice Address - Street 2:SUITE 208
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7331
Practice Address - Country:US
Practice Address - Phone:231-935-5710
Practice Address - Fax:231-935-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB81010OtherBCBSM
MI0M83990Medicare ID - Type Unspecified