Provider Demographics
NPI:1013948686
Name:MICHIGAN LUNG AND CRITICAL CARE SPECIALISTS, PC
Entity Type:Organization
Organization Name:MICHIGAN LUNG AND CRITICAL CARE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-695-4000
Mailing Address - Street 1:9450 S SAGINAW RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8206
Mailing Address - Country:US
Mailing Address - Phone:810-695-4000
Mailing Address - Fax:810-695-4055
Practice Address - Street 1:9450 S SAGINAW RD
Practice Address - Street 2:SUITE E
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8206
Practice Address - Country:US
Practice Address - Phone:810-695-4000
Practice Address - Fax:810-695-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X
MI5101008684261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty