Provider Demographics
NPI:1891736955
Name:INTERNAL MEDICINE ASSOCIATES OF OWOSSO, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF OWOSSO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACAL
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:989-723-5540
Mailing Address - Street 1:300 HEALTH PARK DR.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1292
Mailing Address - Country:US
Mailing Address - Phone:989-723-5540
Mailing Address - Fax:
Practice Address - Street 1:300 HEALTH PARK DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1292
Practice Address - Country:US
Practice Address - Phone:989-723-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICJ3840OtherRAILROAD MEDICARE
MION38780Medicare PIN