Provider Demographics
NPI:1215117023
Name:MONROE GERIATRIC EVAULATION AND MANAGEMENT SERVICES PLLC
Entity type:Organization
Organization Name:MONROE GERIATRIC EVAULATION AND MANAGEMENT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-799-1641
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-0608
Mailing Address - Country:US
Mailing Address - Phone:734-799-1641
Mailing Address - Fax:
Practice Address - Street 1:1030 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-799-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOL045607207R00000X
MI4301050330207R00000X
MIAD054293207RI0011X
MIJS013467207X00000X
MIAR0812652081P2900X
MI5601003734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E811600OtherBCBS GROUP PIN
MI700E811600OtherBCBS GROUP PIN