PROMEDICA CORPORATION OF MICHIGAN (NPI# 1336276542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336276542 |
| Entity Type | Organization |
| Organization Name | PROMEDICA CORPORATION OF MICHIGAN |
| Other Organization Name | RIVER RAISIN ENT |
| Practice Address |
777 Kimole Ln Suite 240 Adrian MI 49221-1478 |
| Practice Telephone | 5172639491 |
| Practice Fax Number | 5172639591 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | KIMBERLY GOVAN (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 4198247221 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | ========= | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2002924 | 05 | |
| MI | RRMC | CD9268 | 01 |
| Other Name | Type Code |
|---|---|
| River Raisin ENT | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518094721 | Promedica Corporation of Michigan | Internal Medicine | 13101 Sims Hwy, Morenci, MI 49256-1030 | 2007-02-27 |
| 1316073703 | Promedica Corporation of Michigan | Family Medicine | 9205 East Us Highway 23, Blissfield, MI 49228 | 2007-02-27 |
| 1689945172 | Promedica Corporation of Michigan | Otolaryngology | 240 W Carleton Rd, Hillsdale, MI 49242-5034 | 2012-01-16 |
| 1083981302 | Promedica Corporation of Michigan | Internal Medicine | 157 W Brooke Ln, Blissfield, MI 49228-8601 | 2011-12-01 |
| 1154548592 | Promedica Corporation of Michigan | Obstetrics & Gynecology | 901 Kimole Ln, Suite A-1, Adrian, MI 49221-1491 | 2007-04-19 |
| 1790812907 | Promedica Corporation of Michigan | Family Medicine | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2007-02-27 |
| 1477689859 | Promedica Corporation of Michigan | Family Medicine | 901 Kimole Ln, Suite A-4, Adrian, MI 49221-1491 | 2007-02-27 |
| 1780711002 | Promedica Corporation of Michigan | Internal Medicine | 1671 W Michigan Ave, Suite A, Clinton, MI 49236-8702 | 2007-02-27 |
| 1942336326 | Promedica Corporation of Michigan | Surgery | 10 Cairns St, Tecumseh, MI 49286-1202 | 2007-02-27 |
| 1588791925 | Promedica Corporation of Michigan | Internal Medicine | 818 Riverside Ave, 5th Floor Cardiology, Adrian, MI 49221-1446 | 2007-02-27 |
| Street Address |
777 KIMOLE LN SUITE 240 |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-1478 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972501138 | Heidi Nichols | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2005-07-12 |
| 1023470614 | Emily Grace Corfman | Speech-Language Pathologist | 777 Kimole Ln, Suite 110, Adrian, MI 49221-1478 | 2016-03-23 |
| 1083098420 | Sarah Farmer | Nurse Practitioner | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2015-07-15 |
| 1194096693 | Promedica Central Physicians | Internal Medicine | 777 Kimole Ln, Suite 250, Adrian, MI 49221-1478 | 2012-01-16 |
| 1376721035 | Konda Bc Mouli, Md PC | Urology | 777 Kimole Ln, Suite 260, Adrian, MI 49221-1478 | 2008-02-05 |
| 1689863391 | Anne Elisabeth Butts | Nurse Practitioner | 777 Kimole Ln, Ste. 260, Adrian, MI 49221-1478 | 2007-10-18 |
| 1285826008 | Annemarie Marwitz Kallenbach | Nurse Practitioner | 777 Kimole Ln, Adrian, MI 49221-1478 | 2007-08-15 |
| 1790812907 | Promedica Corporation of Michigan | Family Medicine | 777 Kimole Ln, Suite 230, Adrian, MI 49221-1478 | 2007-02-27 |
| 1093840381 | Promedica Corporation of Michigan | Surgery | 777 Kimole Ln, Suite 220, Adrian, MI 49221-1478 | 2007-02-23 |
| 1255483038 | Toledo Clinic Incorporated | Durable Medical Equipment & Medical Supplies | 777 Kimole Ln, Suite 130, Adrian, MI 49221-1478 | 2007-01-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
| Find all providers in zip 49221 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326056003 | Samantha M Mucha | Otolaryngology | 777 Kimole Ln, Suite 240, Adrian, MI 49221-1478 | 2006-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104445980 | Anuja Dharap | Otolaryngology | 35630 Grand River Ave Apt 217, Farmington Hills, MI 48335-3120 | 2020-04-13 |
| 1598311334 | Cogent Medical Group Pllc | Otolaryngology | 28300 Orchard Lake Rd Ste 101, Farmington Hills, MI 48334-3704 | 2019-08-16 |
| 1073025334 | Robert J Stachler Md PC | Otolaryngology | 33200 W. 14 Mile Rd., Ste. 240, West Bloomfield, MI 48322 | 2017-10-26 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1174905822 | Scott Jacob Schwartz | Otolaryngology | 6900 Orchard Lake Rd Ste 314, West Bloomfield, MI 48322-3457 | 2015-06-18 |
| 1669868402 | Cameron M Heilbronn | Otolaryngology | 21000 E 12 Mile Rd Ste 111, Saint Clair Shores, MI 48081-1156 | 2015-04-08 |
| 1104230523 | Gary Zachary White | Otolaryngology | 300 North Ave Ste 1400, Battle Creek, MI 49017 | 2014-06-13 |
| 1437574530 | Beacon Medical Group, Inc. | Otolaryngology | 711 S Health Pkwy Ste 1, Medical Office Building #1, Three Rivers, MI 49093-8354 | 2014-02-26 |
| 1124361621 | Eric Fahed Succar | Otolaryngology | 44200 Woodward Ave Ste 201, Pontiac, MI 48341-5045 | 2013-04-03 |
| 1396086286 | Nathan Vandjelovic | Otolaryngology | 4201 Saint Antoine St # 9c, Detroit, MI 48201-2153 | 2013-03-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PROMEDICA CORPORATION OF MICHIGAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.