Provider Demographics
NPI:1336396142
Name:MIDWEST MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:MIDWEST MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-894-6647
Mailing Address - Street 1:6689 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 268
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:248-894-6647
Mailing Address - Fax:248-682-2828
Practice Address - Street 1:G-3422 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:248-894-6647
Practice Address - Fax:248-682-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160H21777OtherBCBS