Provider Demographics
NPI:1295806966
Name:UNITED PHYSICIANS MEDICAL GROUP, PC
Entity type:Organization
Organization Name:UNITED PHYSICIANS MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-0800
Mailing Address - Street 1:1303 S LINDEN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3442
Mailing Address - Country:US
Mailing Address - Phone:810-230-0800
Mailing Address - Fax:810-230-0880
Practice Address - Street 1:1303 S LINDEN RD
Practice Address - Street 2:SUITE F
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3442
Practice Address - Country:US
Practice Address - Phone:810-230-0800
Practice Address - Fax:810-230-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071799208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4660304Medicaid
MI3502511382OtherBLUE CROSS BLUE SHIELD
MI4660304Medicaid
MIH78470Medicare UPIN