Provider Demographics
NPI:1992957708
Name:INFECTIOUS DISEASES OF MICHIGAN PC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-332-8404
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-0069
Mailing Address - Country:US
Mailing Address - Phone:248-332-8404
Mailing Address - Fax:248-332-0952
Practice Address - Street 1:4400 DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3567
Practice Address - Country:US
Practice Address - Phone:248-332-8404
Practice Address - Fax:248-332-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010780207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36896OtherBC/BS
MIMI1364Medicare PIN
MIMI1365Medicare PIN
MIG06515Medicare UPIN