Provider Demographics
NPI:1689746901
Name:MICHIGAN RHEUMATOLOGY GROUP PC
Entity Type:Organization
Organization Name:MICHIGAN RHEUMATOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTOSH MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:810-953-8700
Mailing Address - Street 1:8200 S SAGINAW ST STE 500
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2451
Mailing Address - Country:US
Mailing Address - Phone:810-953-8700
Mailing Address - Fax:810-953-8704
Practice Address - Street 1:8200 S SAGINAW ST STE 500
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2451
Practice Address - Country:US
Practice Address - Phone:810-953-8700
Practice Address - Fax:810-953-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N87290Medicare ID - Type UnspecifiedMEDICARE