Provider Demographics
NPI:1467660449
Name:JAMES ROBERT LITTLE MD PC
Entity Type:Organization
Organization Name:JAMES ROBERT LITTLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-6900
Mailing Address - Street 1:35200 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4837
Mailing Address - Country:US
Mailing Address - Phone:586-826-8600
Mailing Address - Fax:586-826-8931
Practice Address - Street 1:35200 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4837
Practice Address - Country:US
Practice Address - Phone:586-826-8600
Practice Address - Fax:586-826-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL063594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4182387Medicaid
MI0N77380Medicare PIN
MI4182387Medicaid