Provider Demographics
NPI:1669504882
Name:PERSSON INTERNAL MEDICINE,P.C
Entity Type:Organization
Organization Name:PERSSON INTERNAL MEDICINE,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-843-3600
Mailing Address - Street 1:5 N ATKINSON DR
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2918
Mailing Address - Country:US
Mailing Address - Phone:231-843-3600
Mailing Address - Fax:231-845-9887
Practice Address - Street 1:5 N ATKINSON DR
Practice Address - Street 2:SUITE #207
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2918
Practice Address - Country:US
Practice Address - Phone:231-843-3600
Practice Address - Fax:231-845-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1155300024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N99180Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MI0N99170Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER