Provider Demographics
NPI:1851454524
Name:RIMA JIBALY M.D. , P.C
Entity Type:Organization
Organization Name:RIMA JIBALY M.D. , P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIBALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, BS
Authorized Official - Phone:810-691-0171
Mailing Address - Street 1:1123 VILLA LINDE CT
Mailing Address - Street 2:SUITE 38
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
Mailing Address - Country:US
Mailing Address - Phone:810-733-7221
Mailing Address - Fax:810-733-7280
Practice Address - Street 1:1123 VILLA LINDE CT
Practice Address - Street 2:SUITE 38
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-733-7221
Practice Address - Fax:810-733-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069514261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG96173Medicare UPIN