Provider Demographics
NPI:1679663264
Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHEAST MICHIGAN PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHEAST MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BALEMBA
Authorized Official - Last Name:MEKAI-VEKIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-480-1400
Mailing Address - Street 1:5429 WHITTAKER ROAD
Mailing Address - Street 2:INTERNAL MEDICINE ASSOCIATES OF SOUTH EAST MICHIGAN
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-480-1400
Mailing Address - Fax:734-480-1456
Practice Address - Street 1:5429 WHITTAKER ROAD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-480-1400
Practice Address - Fax:734-480-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070863261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4471817Medicaid
1679663264OtherNPI
MIP00282079OtherRAIL ROAD MEDICARE
MI4301070863OtherLICENSE
MI4471817Medicaid
MI0N65500Medicare PIN