Provider Demographics
NPI:1992781066
Name:BLISSFIELD INTERNAL MEDICINE
Entity type:Organization
Organization Name:BLISSFIELD INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-486-2411
Mailing Address - Street 1:157 W BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-8601
Mailing Address - Country:US
Mailing Address - Phone:517-486-2411
Mailing Address - Fax:517-486-3967
Practice Address - Street 1:157 W BROOKE LN
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-8601
Practice Address - Country:US
Practice Address - Phone:517-486-2411
Practice Address - Fax:517-486-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM044007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4711360Medicaid
MI4711350Medicaid
MITM044007Medicare ID - Type Unspecified
MIEN010222Medicare ID - Type Unspecified
MIB46092Medicare UPIN
MI4711360Medicaid