Provider Demographics
NPI:1174544050
Name:LIFETIME MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LIFETIME MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-293-1002
Mailing Address - Street 1:1701 SOUTH BLVD E STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6123
Mailing Address - Country:US
Mailing Address - Phone:248-293-1002
Mailing Address - Fax:248-293-1272
Practice Address - Street 1:1701 SOUTH BLVD E STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6123
Practice Address - Country:US
Practice Address - Phone:248-293-1002
Practice Address - Fax:248-293-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3522770Medicaid
MI3522770Medicaid