Provider Demographics
NPI:1982709374
Name:GENESEE INFECTIOUS DISEASES, PLC
Entity Type:Organization
Organization Name:GENESEE INFECTIOUS DISEASES, PLC
Other - Org Name:GENESEE INFECTIOUS DISEASES & TRAVEL MEDICINE CENTER, PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-655-0027
Mailing Address - Street 1:6060 TORREY RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5963
Mailing Address - Country:US
Mailing Address - Phone:810-655-0027
Mailing Address - Fax:810-655-0093
Practice Address - Street 1:6060 TORREY RD
Practice Address - Street 2:SUITE I
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5963
Practice Address - Country:US
Practice Address - Phone:810-655-0027
Practice Address - Fax:810-655-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008932207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4760909Medicaid
MI0P18530Medicare ID - Type UnspecifiedMEDICARE
MI4760909Medicaid