Provider Demographics
NPI:1811138308
Name:SOUTHEASTERN MICHIGAN PRIMARY CARE PARTNERS, PLLC
Entity type:Organization
Organization Name:SOUTHEASTERN MICHIGAN PRIMARY CARE PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMPTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-483-1988
Mailing Address - Street 1:1159 E MICHIGAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5807
Mailing Address - Country:US
Mailing Address - Phone:734-483-1988
Mailing Address - Fax:734-483-4877
Practice Address - Street 1:1159 E MICHIGAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5807
Practice Address - Country:US
Practice Address - Phone:734-483-1988
Practice Address - Fax:734-483-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty