Provider Demographics
NPI:1639509466
Name:ADVANCED EMG OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:ADVANCED EMG OF MICHIGAN, PLLC
Other - Org Name:ADVANCED EMG OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-2377
Mailing Address - Street 1:37504 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1004
Mailing Address - Country:US
Mailing Address - Phone:734-779-2377
Mailing Address - Fax:734-779-2378
Practice Address - Street 1:37504 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1004
Practice Address - Country:US
Practice Address - Phone:734-779-2377
Practice Address - Fax:734-779-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7554Medicare UPIN