Basic Information
| Provider Information | |||||||||
| NPI: | 1225295660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN MEDICAL MANAGEMENT INC | ||||||||
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| OtherOrganizationName: | MCLAREN MEDICAL MANAGEMENT - CONVENIENT CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 10090 E LIPPINCOTT BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484239151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106586528 | ||||||||
| FaxNumber: | 8106538589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | KANE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CORP DIRECTOR PHYSICIAN BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8103421530 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MCLAREN MEDICAL MANAGEMENT INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.