Provider Demographics
NPI:1306842190
Name:INTERNAL MEDICINE ASSOCIATES OF MT. CLEMENS, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF MT. CLEMENS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:H
Authorized Official - Last Name:FINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-468-1600
Mailing Address - Street 1:133 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2308
Mailing Address - Country:US
Mailing Address - Phone:586-468-1600
Mailing Address - Fax:586-465-0329
Practice Address - Street 1:133 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2308
Practice Address - Country:US
Practice Address - Phone:586-468-1600
Practice Address - Fax:586-465-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-26
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6249440001Medicare NSC
MIOM332000Medicare PIN