Provider Demographics
NPI:1467772483
Name:AMERIGARD DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:AMERIGARD DEVELOPMENT CORPORATION
Other - Org Name:PLYMOUTH INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-458-4490
Mailing Address - Street 1:261 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1637
Mailing Address - Country:US
Mailing Address - Phone:734-414-8040
Mailing Address - Fax:734-414-8045
Practice Address - Street 1:261 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1637
Practice Address - Country:US
Practice Address - Phone:734-414-8040
Practice Address - Fax:734-414-8045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIGARD DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26334Medicare PIN