Provider Demographics
NPI:1104367242
Name:MICHIGAN HEALTH SPECIALIST, LLC
Entity type:Organization
Organization Name:MICHIGAN HEALTH SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUCCINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-309-9734
Mailing Address - Street 1:G3494 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2735
Mailing Address - Country:US
Mailing Address - Phone:810-309-9734
Mailing Address - Fax:
Practice Address - Street 1:G3494 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2735
Practice Address - Country:US
Practice Address - Phone:810-309-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty