Provider Demographics
NPI:1194981415
Name:RICHARD P. PAYEA, M.D., PC
Entity type:Organization
Organization Name:RICHARD P. PAYEA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAYEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-362-2141
Mailing Address - Street 1:1195 TAWAS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9346
Mailing Address - Country:US
Mailing Address - Phone:989-362-2141
Mailing Address - Fax:989-362-7740
Practice Address - Street 1:1195 TAWAS BEACH RD
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9346
Practice Address - Country:US
Practice Address - Phone:989-362-2141
Practice Address - Fax:989-362-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2800540Medicaid
MIM012702OtherTRICARE
MI0803500302OtherBCBS
MI0803500302OtherBCBS
MIB46105Medicare UPIN