Provider Demographics
NPI:1881172989
Name:GERIATRIC ASSOCIATES OF MICHIGAN, PLLC
Entity type:Organization
Organization Name:GERIATRIC ASSOCIATES OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-524-0897
Mailing Address - Street 1:28655 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4105
Mailing Address - Country:US
Mailing Address - Phone:586-393-1330
Mailing Address - Fax:586-393-1308
Practice Address - Street 1:28655 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4105
Practice Address - Country:US
Practice Address - Phone:586-393-1330
Practice Address - Fax:586-393-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty