Provider Demographics
NPI:1851330773
Name:PULMONARY & CRITICAL CARE MEDICINE CONSULTANTS PC
Entity type:Organization
Organization Name:PULMONARY & CRITICAL CARE MEDICINE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLDOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-922-9283
Mailing Address - Street 1:5701 BOW POINTE DR STE 365
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5403
Mailing Address - Country:US
Mailing Address - Phone:248-922-9283
Mailing Address - Fax:248-922-9286
Practice Address - Street 1:5701 BOW POINTE DR STE 365
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5403
Practice Address - Country:US
Practice Address - Phone:248-922-9283
Practice Address - Fax:248-922-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006431207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F363740Medicare ID - Type UnspecifiedMEDICARE COMMON