Provider Demographics
NPI:1578777165
Name:BIRMINGHAM MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BIRMINGHAM MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN'S ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWELS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:248-720-0277
Mailing Address - Street 1:306 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1742
Mailing Address - Country:US
Mailing Address - Phone:248-720-0277
Mailing Address - Fax:248-720-0276
Practice Address - Street 1:306 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1742
Practice Address - Country:US
Practice Address - Phone:248-720-0277
Practice Address - Fax:248-720-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1156314624OtherBCBS MICHIGAN
MICJ7818OtherRR MEDICARE LISA SOWELS
MIDD2338OtherRR MEDICARE ANGELA HAMLIN
MIDD2338OtherRR MEDICARE ANGELA HAMLIN
MI0P04280Medicare ID - Type UnspecifiedLISA SOWELS, PA-C