Provider Demographics
NPI:1013939073
Name:PHYSICIAN IN-HOME SERVICES, PC
Entity Type:Organization
Organization Name:PHYSICIAN IN-HOME SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINVAL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:FLEETWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-239-7684
Mailing Address - Street 1:1415 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-3530
Mailing Address - Country:US
Mailing Address - Phone:810-239-7684
Mailing Address - Fax:810-239-4921
Practice Address - Street 1:1415 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3530
Practice Address - Country:US
Practice Address - Phone:810-239-7684
Practice Address - Fax:810-239-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILF034519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty