Provider Demographics
NPI:1346508306
Name:PALLIATIVE MEDICINE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PALLIATIVE MEDICINE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-923-4485
Mailing Address - Street 1:2346 S COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2126
Mailing Address - Country:US
Mailing Address - Phone:810-923-4485
Mailing Address - Fax:248-849-2834
Practice Address - Street 1:2346 S COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-2126
Practice Address - Country:US
Practice Address - Phone:810-923-4485
Practice Address - Fax:248-849-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010450582084H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154306355OtherNPI (INDIVIDUAL PROVIDER)
MI4301045058OtherSTATE LICENSE