Provider Demographics
NPI:1992881767
Name:ASSOCIATES OF INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:ASSOCIATES OF INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-720-2626
Mailing Address - Street 1:38865 DEQUINDRE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6812
Mailing Address - Country:US
Mailing Address - Phone:248-720-2626
Mailing Address - Fax:
Practice Address - Street 1:38865 DEQUINDRE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6812
Practice Address - Country:US
Practice Address - Phone:248-720-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES OF INTERNAL MEDICINE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3220859Medicaid
MI3220868Medicaid
MICI6216OtherMEDICARE RAILROAD
MA4188667Medicaid
MI3220859Medicaid
MI3220859Medicaid
MIE38470Medicare UPIN
MIOM12070Medicare PIN
MIG99137Medicare UPIN