Provider Demographics
NPI:1871664136
Name:MICHIGAN DIGESTIVE ASSOCIATES PC
Entity Type:Organization
Organization Name:MICHIGAN DIGESTIVE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALUCM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-758-0730
Mailing Address - Street 1:43368 WOODWARD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5051
Mailing Address - Country:US
Mailing Address - Phone:248-758-0730
Mailing Address - Fax:248-758-2060
Practice Address - Street 1:43368 WOODWARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5051
Practice Address - Country:US
Practice Address - Phone:248-758-0730
Practice Address - Fax:248-758-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P38420Medicare ID - Type Unspecified