Provider Demographics
NPI:1922110477
Name:GENESEE LUNG ASSOCIATES PC
Entity Type:Organization
Organization Name:GENESEE LUNG ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:GHATH
Authorized Official - Last Name:BAYASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-695-5864
Mailing Address - Street 1:8220 S SAGINAW ST STE 800
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1890
Mailing Address - Country:US
Mailing Address - Phone:810-695-5864
Mailing Address - Fax:810-695-2412
Practice Address - Street 1:8220 S SAGINAW ST STE 800
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1890
Practice Address - Country:US
Practice Address - Phone:106-955-8648
Practice Address - Fax:106-952-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B56209Medicare ID - Type UnspecifiedGROUP MEDICARE