Provider Demographics
NPI:1568496370
Name:FARMINGTON EMERGENCY MEDICINE
Entity Type:Organization
Organization Name:FARMINGTON EMERGENCY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-540-8739
Mailing Address - Street 1:PO BOX 634087
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263
Mailing Address - Country:US
Mailing Address - Phone:800-540-8739
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:28050 GRAND RIVER AVENUE
Practice Address - Street 2:ER DEPT
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-471-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F301700OtherBCBS OF MICHIGAN
MIN83060Medicare PIN