Provider Demographics
NPI:1275720625
Name:MICHIGAN MEDICINE SPECIALISTS PLLC
Entity Type:Organization
Organization Name:MICHIGAN MEDICINE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-264-4261
Mailing Address - Street 1:35429 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4258
Mailing Address - Country:US
Mailing Address - Phone:586-264-4261
Mailing Address - Fax:586-264-4707
Practice Address - Street 1:35429 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4258
Practice Address - Country:US
Practice Address - Phone:586-264-4261
Practice Address - Fax:586-264-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION82360Medicare PIN