Provider Demographics
NPI:1811099583
Name:MARTIN GARBER DO AND KATHLEEN MENEREY MD PC
Entity type:Organization
Organization Name:MARTIN GARBER DO AND KATHLEEN MENEREY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-477-0211
Mailing Address - Street 1:3145 W CLARK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1120
Mailing Address - Country:US
Mailing Address - Phone:734-477-0211
Mailing Address - Fax:
Practice Address - Street 1:3145 W CLARK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1120
Practice Address - Country:US
Practice Address - Phone:734-477-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009637207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4150740Medicaid
MI4150730Medicaid
MIE77787Medicare UPIN
MI0M90180Medicare ID - Type UnspecifiedMEDICARE
MI4150730Medicaid