Provider Demographics
NPI:1639387244
Name:MICHIGAN GASTROENTEROLOGY CLINIC, PC
Entity Type:Organization
Organization Name:MICHIGAN GASTROENTEROLOGY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHANEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMOUNAJED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-7600
Mailing Address - Street 1:5059 VILLA LINDE PKWY STE 28
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3438
Mailing Address - Country:US
Mailing Address - Phone:810-720-7600
Mailing Address - Fax:
Practice Address - Street 1:5059 VILLA LINDE PKWY STE 28
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3438
Practice Address - Country:US
Practice Address - Phone:810-720-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGA069125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102504982OtherBCBSM
MI1102504982OtherBCBSM
MI0M99800Medicare PIN