Provider Demographics
NPI:1174693097
Name:MICHIGAN ADULT & CHILD MEDICINE
Entity type:Organization
Organization Name:MICHIGAN ADULT & CHILD MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BELBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-751-0732
Mailing Address - Street 1:8545 COMMON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-751-0732
Mailing Address - Fax:586-751-3822
Practice Address - Street 1:8545 COMMON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-751-0732
Practice Address - Fax:586-751-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty