Provider Demographics
NPI:1649319526
Name:INTERNAL MEDICINE ASSOCIATES, PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHBOUB
Authorized Official - Suffix:VI
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-5390
Mailing Address - Street 1:5039 VILLA LINDE PKWY
Mailing Address - Street 2:SUITE 31
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3450
Mailing Address - Country:US
Mailing Address - Phone:810-733-5390
Mailing Address - Fax:810-733-6090
Practice Address - Street 1:5039 VILLA LINDE PKWY
Practice Address - Street 2:SUITE 31
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3450
Practice Address - Country:US
Practice Address - Phone:810-733-5390
Practice Address - Fax:810-733-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIT053374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N85110Medicare ID - Type Unspecified
MIE90791Medicare UPIN