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57392 M 51 S Dowagiac MI 49047-9766 | |
(269) 462-9587 | |
(269) 462-9589 |
Full Name | |
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Speciality | Internal Medicine |
Location | 57392 M 51 S, Dowagiac, Michigan |
Authorized Official Name and Position | Kathleen Basha (PROVIDER) |
Authorized Official Contact | 2694629587 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 364 Dowagiac MI 49047-0364 Ph: (269) 462-9587 | 57392 M 51 S Dowagiac MI 49047-9766 Ph: (269) 462-9587 |
NPI Number | 1427723675 |
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Provider Enumeration Date | 08/10/2021 |
Last Update Date | 09/25/2023 |
Medicare PECOS PAC ID | 4284027921 |
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Medicare Enrollment ID | O20220202000452 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427723675 | NPI | - | NPPES |
74575 | Medicaid | MI | |
4837343 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Lakeland Community Hospital Watervliet Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Main St, Dowagiac, MI 49047 Phone: 269-390-0536 | |
Boonchoo Chang M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 417 W High St, Dowagiac, MI 49047 Phone: 269-782-7150 Fax: 269-782-7020 | |