Provider Demographics
NPI:1033301569
Name:BAN MECHAEL, MD PC
Entity type:Organization
Organization Name:BAN MECHAEL, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-476-6209
Mailing Address - Street 1:19930 FARMINGTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1433
Mailing Address - Country:US
Mailing Address - Phone:248-476-6209
Mailing Address - Fax:248-476-6237
Practice Address - Street 1:19930 FARMINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1433
Practice Address - Country:US
Practice Address - Phone:248-476-6209
Practice Address - Fax:248-476-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4409310Medicaid
MI0N50840Medicare PIN
MIF97855Medicare UPIN