Provider Demographics
NPI:1245680578
Name:MIDMICHIGAN GERIATRICS PLC
Entity type:Organization
Organization Name:MIDMICHIGAN GERIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ASIM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-791-4100
Mailing Address - Street 1:912 S WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2578
Mailing Address - Country:US
Mailing Address - Phone:989-791-4100
Mailing Address - Fax:989-791-4114
Practice Address - Street 1:912 S WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2564
Practice Address - Country:US
Practice Address - Phone:989-791-4100
Practice Address - Fax:989-791-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty