Provider Demographics
NPI:1386740025
Name:MORGAN MEDICAL MANAGEMENT, PC
Entity type:Organization
Organization Name:MORGAN MEDICAL MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLEMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDALES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-366-9504
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0609
Mailing Address - Country:US
Mailing Address - Phone:248-366-9504
Mailing Address - Fax:
Practice Address - Street 1:2775 BLAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8838
Practice Address - Country:US
Practice Address - Phone:517-787-2906
Practice Address - Fax:517-787-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25632OtherHEALTH ALLIANCE PLAN
MI0M88860Medicare ID - Type UnspecifiedANESTHESIOLOGISTS
MI0M88660Medicare ID - Type UnspecifiedCRNAS
MIE25632OtherHEALTH ALLIANCE PLAN