Provider Demographics
NPI:1518156645
Name:BLOOMFIELD INTERNAL MEDICINE ASSOC PC
Entity Type:Organization
Organization Name:BLOOMFIELD INTERNAL MEDICINE ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2483-388-2220
Mailing Address - Street 1:43494 WOODWARD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5052
Mailing Address - Country:US
Mailing Address - Phone:248-338-8220
Mailing Address - Fax:
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5052
Practice Address - Country:US
Practice Address - Phone:248-338-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101394062Medicaid
MIB43935Medicare UPIN
MI0M56780Medicare PIN