Provider Demographics
NPI:1922120070
Name:MACOMB MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:MACOMB MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-264-1800
Mailing Address - Street 1:2405 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5961
Mailing Address - Country:US
Mailing Address - Phone:586-264-1800
Mailing Address - Fax:586-264-1155
Practice Address - Street 1:2405 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5961
Practice Address - Country:US
Practice Address - Phone:586-264-1800
Practice Address - Fax:586-264-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0503490OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0M32970Medicare PIN