Provider Demographics
NPI:1710980586
Name:INTERNAL MEDICINE ASSOCIATES OF FLINT P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF FLINT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEDEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-230-0120
Mailing Address - Street 1:3499 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3022
Mailing Address - Country:US
Mailing Address - Phone:810-230-0120
Mailing Address - Fax:810-230-6733
Practice Address - Street 1:G5607 W. BRISTOL RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-230-0120
Practice Address - Fax:810-230-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEC023744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710980586OtherNPI
MI110B56381OtherBCBS
MI5173988OtherCIGNA
MICB7526OtherMEDICARE RAILROAD
MI5173988OtherCIGNA