Provider Demographics
NPI:1528599479
Name:GENESEE COLO-RECTAL CENTER PC
Entity Type:Organization
Organization Name:GENESEE COLO-RECTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHALABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-591-7649
Mailing Address - Street 1:8308 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8881
Mailing Address - Country:US
Mailing Address - Phone:410-591-7649
Mailing Address - Fax:
Practice Address - Street 1:1020 CHARTER DR STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-893-5400
Practice Address - Fax:810-893-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty