Provider Demographics
NPI:1831317536
Name:GENESYS INTEGRATED GROUP PRACTICE PC
Entity Type:Organization
Organization Name:GENESYS INTEGRATED GROUP PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FIANANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-424-2136
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:1096 S BELSAY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-743-3351
Practice Address - Fax:810-244-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M23560BOtherHEALTH ALLIANCE PLAN
MI700B551760OtherBLUE CARE NETWORK
MIUC250004OtherM-CARE PIN
MI2428253OtherHEALTHPLUS OF MICHIGAN
MIUC250004OtherM-CARE PIN