Provider Demographics
NPI:1265455299
Name:OWOSSO INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:OWOSSO INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-723-2299
Mailing Address - Street 1:300 HEALTH PARK DR.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-2299
Mailing Address - Fax:989-729-9109
Practice Address - Street 1:300 HEALTH PARK DR.
Practice Address - Street 2:SUITE 303
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-2299
Practice Address - Fax:989-729-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P19930Medicare PIN