Provider Demographics
NPI:1477861045
Name:THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN LLC
Entity type:Organization
Organization Name:THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-489-2198
Mailing Address - Street 1:6240 RASHELLE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3934
Mailing Address - Country:US
Mailing Address - Phone:810-600-4000
Mailing Address - Fax:810-600-4200
Practice Address - Street 1:6240 RASHELLE DR STE 101
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3938
Practice Address - Country:US
Practice Address - Phone:810-600-4000
Practice Address - Fax:810-600-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P48090Medicare UPIN