Provider Demographics
NPI:1346249547
Name:NORTHEAST MICHIGAN PULMONARY ASSOCIATES
Entity Type:Organization
Organization Name:NORTHEAST MICHIGAN PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-9200
Mailing Address - Street 1:800 COOPER AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5394
Mailing Address - Country:US
Mailing Address - Phone:989-753-9200
Mailing Address - Fax:989-753-2198
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5394
Practice Address - Country:US
Practice Address - Phone:989-753-9200
Practice Address - Fax:989-753-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0982484OtherHEALTH PLUS
MI0G31026OtherBLUE CARE NETWORK OF MI
MI4522980Medicaid
MI0678331OtherHEALTH PLUS
MI2119375Medicaid
MI4229151Medicaid
MI0995262OtherHEALTH PLUS
MI2119375Medicaid
MI0678331OtherHEALTH PLUS
MIB44365Medicare UPIN
MI0M53370Medicare ID - Type Unspecified