Provider Demographics
NPI:1518149343
Name:MICHIGAN MEDICAL DOCTORS PLLC
Entity Type:Organization
Organization Name:MICHIGAN MEDICAL DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-545-2131
Mailing Address - Street 1:1380 COOLIDGE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MD
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-545-2131
Mailing Address - Fax:248-545-4737
Practice Address - Street 1:1380 COOLIDGE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MD
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-545-2131
Practice Address - Fax:248-545-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N99960Medicare PIN