Provider Demographics
NPI:1255429007
Name:GERIATRIC AND MEDICAL SPECIALISTS OF MICHIGAN P L C
Entity type:Organization
Organization Name:GERIATRIC AND MEDICAL SPECIALISTS OF MICHIGAN P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-235-2599
Mailing Address - Street 1:5155 NORKO DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-720-6700
Mailing Address - Fax:810-743-1610
Practice Address - Street 1:2700 ROBERT T LONGWAY BLVD
Practice Address - Street 2:STE #A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2190
Practice Address - Country:US
Practice Address - Phone:810-720-6700
Practice Address - Fax:810-743-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 363LG0600X, 363L00000X, 207RG0300X
MI4301405199207R00000X
MI6801035828104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P45610Medicare PIN
MI0P23940Medicare ID - Type Unspecified