Basic Information
| Provider Information | |||||||||
| NPI: | 1013353929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN MEDICAL MANAGEMENT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
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| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 AMES ST | ||||||||
| Address2: | |||||||||
| City: | ELK RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496299449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2312648282 | ||||||||
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| ProviderEnumerationDate: | 05/18/2013 | ||||||||
| LastUpdateDate: | 05/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | DIMOND | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8103421073 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.