Provider Demographics
NPI:1801968144
Name:MICHIGAN RHEUMATOLOGY GROUP PC
Entity type:Organization
Organization Name:MICHIGAN RHEUMATOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTOSH MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-667-0067
Mailing Address - Street 1:1254 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1343
Mailing Address - Country:US
Mailing Address - Phone:810-667-4356
Mailing Address - Fax:810-667-7356
Practice Address - Street 1:1254 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1343
Practice Address - Country:US
Practice Address - Phone:810-667-0067
Practice Address - Fax:810-667-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N87290Medicare ID - Type Unspecified