Provider Demographics
NPI:1467502252
Name:MICHIGAN INTERNAL MEDICINE & PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:MICHIGAN INTERNAL MEDICINE & PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PUNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-630-0404
Mailing Address - Street 1:9001 MILLER ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473
Mailing Address - Country:US
Mailing Address - Phone:810-630-0404
Mailing Address - Fax:810-630-2306
Practice Address - Street 1:9001 MILLER ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473
Practice Address - Country:US
Practice Address - Phone:810-630-0404
Practice Address - Fax:810-630-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072232207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4971064Medicaid
MI1102513001OtherBCBSM
MI1102513001OtherBCBSM
MIOP40470Medicare PIN