Provider Demographics
NPI:1508813114
Name:ALLEGAN INTERNAL MEDICINE, P. C
Entity Type:Organization
Organization Name:ALLEGAN INTERNAL MEDICINE, P. C
Other - Org Name:THOMAS STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-673-2179
Mailing Address - Street 1:305 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9158
Mailing Address - Country:US
Mailing Address - Phone:269-673-2179
Mailing Address - Fax:269-673-6992
Practice Address - Street 1:305 THOMAS ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9158
Practice Address - Country:US
Practice Address - Phone:269-673-2179
Practice Address - Fax:269-673-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110Z310760OtherBLUE CROSS PIN
MI0P32390Medicare PIN