Provider Demographics
NPI:1780864736
Name:BICOUNTY MEDICAL PRACTICES
Entity Type:Organization
Organization Name:BICOUNTY MEDICAL PRACTICES
Other - Org Name:HENRY FORD INTERNAL MEDICINE - WARREN
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLOMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-759-7988
Mailing Address - Street 1:13355 E 10 MILE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2048
Mailing Address - Country:US
Mailing Address - Phone:586-759-1080
Mailing Address - Fax:586-759-1085
Practice Address - Street 1:13355 E 10 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-759-1080
Practice Address - Fax:586-759-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N65730Medicare PIN