| Imid Consultants Pc | |
|
2300 Haggerty Ste 1190 W Bloomfield MI 48322 | |
| (248) 229-6255 | |
| (248) 624-9825 |
| Full Name | Imid Consultants Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2300 Haggerty, W Bloomfield, Michigan |
| Authorized Official Name and Position | Brenda Lee Luther (SENIOR BILLER) |
| Authorized Official Contact | 2482296255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imid Consultants Pc Po Box 33321 Drawer 110 Detroit MI 48232-5321 Ph: (248) 229-6255 | Imid Consultants Pc 2300 Haggerty Ste 1190 W Bloomfield MI 48322 Ph: (248) 229-6255 |
| NPI Number | 1194742940 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0648255729 |
|---|---|
| Medicare Enrollment ID | O20040622001431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194742940 | NPI | - | NPPES |
| 1106320881 | Other | BC | |
| 4474944 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 4301054621 (Michigan) | Primary |
| Provider Name | James Jay Gordon |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144239559 PECOS PAC ID: 8426033507 Enrollment ID: I20040622001515 |
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