Provider Demographics
NPI:1598503799
Name:MICHIGAN HEALTH ASSOCIATES
Entity type:Organization
Organization Name:MICHIGAN HEALTH ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ELNAEM
Authorized Official - Last Name:GISMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-627-0360
Mailing Address - Street 1:6139 GAITWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7437
Mailing Address - Country:US
Mailing Address - Phone:313-627-0360
Mailing Address - Fax:
Practice Address - Street 1:5061 VILLA LINDE PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3412
Practice Address - Country:US
Practice Address - Phone:810-733-6000
Practice Address - Fax:810-733-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty