Provider Demographics
NPI:1194147694
Name:BIANCO INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:BIANCO INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-254-2333
Mailing Address - Street 1:12315 CRABAPPLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6329
Mailing Address - Country:US
Mailing Address - Phone:678-254-2333
Mailing Address - Fax:678-254-2332
Practice Address - Street 1:12315 CRABAPPLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6329
Practice Address - Country:US
Practice Address - Phone:678-254-2333
Practice Address - Fax:678-254-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G704814Medicare PIN