Provider Demographics
NPI:1417160698
Name:DOWNRIVER INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:DOWNRIVER INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-479-1944
Mailing Address - Street 1:14700 KING RD
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7909
Mailing Address - Country:US
Mailing Address - Phone:734-479-1944
Mailing Address - Fax:734-479-1253
Practice Address - Street 1:14700 KING RD
Practice Address - Street 2:STE A
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7909
Practice Address - Country:US
Practice Address - Phone:734-479-1944
Practice Address - Fax:734-479-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14790001Medicare PIN
MI0N14790Medicare PIN