Provider Demographics
NPI:1417174319
Name:PULMONARY AND MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:PULMONARY AND MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-751-8844
Mailing Address - Street 1:27472 SCHOENHERR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6675
Mailing Address - Country:US
Mailing Address - Phone:586-751-8844
Mailing Address - Fax:586-751-8596
Practice Address - Street 1:27472 SCHOENHERR RD STE 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6675
Practice Address - Country:US
Practice Address - Phone:586-751-8844
Practice Address - Fax:586-751-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E014540OtherBLUE CROSS GROUP NUMBER
MI700E014540OtherBLUE CROSS GROUP NUMBER