Basic Information
| Provider Information | |||||||||
| NPI: | 1518004407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN MEDICAL MANAGEMENT INC. | ||||||||
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| OtherOrganizationName: | MCLAREN MEDICAL MANAGEMENT -RADIOLOGY-FLINT | ||||||||
| 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: | 1314 S LINDEN RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421730 | ||||||||
| FaxNumber: | 8107203482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | KANE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CORP DIRECTOR PHYSICIAN BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8103421530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.