Provider Demographics
NPI:1154560571
Name:MEDITERRANEAN ASSOCIATION PLLC
Entity type:Organization
Organization Name:MEDITERRANEAN ASSOCIATION PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIMASI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-477-1800
Mailing Address - Street 1:35525 GARFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5521
Mailing Address - Country:US
Mailing Address - Phone:586-477-1800
Mailing Address - Fax:586-477-1815
Practice Address - Street 1:35525 GARFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-5521
Practice Address - Country:US
Practice Address - Phone:586-477-1800
Practice Address - Fax:586-477-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4117Medicare PIN