Provider Demographics
NPI:1386104628
Name:INTERNAL MEDICINE AT HOME PLLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE AT HOME PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:586-843-3815
Mailing Address - Street 1:41400 DEQUINDRE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3751
Mailing Address - Country:US
Mailing Address - Phone:586-843-3815
Mailing Address - Fax:586-843-3920
Practice Address - Street 1:17000 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1263
Practice Address - Country:US
Practice Address - Phone:586-563-5555
Practice Address - Fax:586-563-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty