Provider Demographics
NPI:1437401692
Name:NBO MEDICAL
Entity Type:Organization
Organization Name:NBO MEDICAL
Other - Org Name:NBO MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEWEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-999-9020
Mailing Address - Street 1:3410 BELLE CHASE WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-999-9020
Mailing Address - Fax:517-999-0096
Practice Address - Street 1:3410 BELLE CHASE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-332-7246
Practice Address - Fax:517-332-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty