Provider Demographics
NPI:1790004109
Name:HEALTH MANAGEMENT COSULTIONS
Entity Type:Organization
Organization Name:HEALTH MANAGEMENT COSULTIONS
Other - Org Name:REDICARE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-694-4134
Mailing Address - Street 1:6910 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6912
Mailing Address - Country:US
Mailing Address - Phone:517-694-4134
Mailing Address - Fax:517-908-3981
Practice Address - Street 1:6910 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6912
Practice Address - Country:US
Practice Address - Phone:517-694-4134
Practice Address - Fax:517-908-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP008207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700C361780OtherBLUE CROSS ID
MI0M08460Medicare PIN