Provider Demographics
NPI:1295757854
Name:MICHIGAN INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:MICHIGAN INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-9323
Mailing Address - Street 1:3400 FLECKENSTEIN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3043
Mailing Address - Country:US
Mailing Address - Phone:810-230-9323
Mailing Address - Fax:810-230-9328
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3043
Practice Address - Country:US
Practice Address - Phone:810-230-9323
Practice Address - Fax:810-230-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4371320Medicaid
MI0N83640Medicare ID - Type Unspecified
MIG33849Medicare UPIN