Provider Demographics
NPI:1053351551
Name:INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF LIVINGSTON COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR INPATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-231-2814
Mailing Address - Street 1:7305 E M 36
Mailing Address - Street 2:PO BOX 829
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9715
Mailing Address - Country:US
Mailing Address - Phone:810-231-2814
Mailing Address - Fax:810-231-6080
Practice Address - Street 1:620 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1002
Practice Address - Country:US
Practice Address - Phone:517-545-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M37250Medicare ID - Type Unspecified