Provider Demographics
NPI:1912354986
Name:MICHIGAN INDEPENDENT PHYSICIANS ASSOCIATION, PLC
Entity Type:Organization
Organization Name:MICHIGAN INDEPENDENT PHYSICIANS ASSOCIATION, PLC
Other - Org Name:MICHIGAN IPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BOUVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-610-7972
Mailing Address - Street 1:12821 S SAGINAW ST
Mailing Address - Street 2:D13
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2457
Mailing Address - Country:US
Mailing Address - Phone:810-344-9213
Mailing Address - Fax:810-953-2964
Practice Address - Street 1:12821 S SAGINAW ST
Practice Address - Street 2:D13
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2457
Practice Address - Country:US
Practice Address - Phone:810-344-9213
Practice Address - Fax:810-953-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty