Provider Demographics
NPI:1780696328
Name:MICHIGAN MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MICHIGAN MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-453-5100
Mailing Address - Street 1:851 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2086
Mailing Address - Country:US
Mailing Address - Phone:734-453-5100
Mailing Address - Fax:734-453-3538
Practice Address - Street 1:851 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2086
Practice Address - Country:US
Practice Address - Phone:734-453-5100
Practice Address - Fax:734-453-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649242280Other1649242280
MI15786063Other1578608063