| Ascension Medical Group Genesys | |
|
3495 S Center Rd Burton MI 48519-1455 | |
| (810) 424-2136 | |
| (810) 249-4149 |
| Full Name | Ascension Medical Group Genesys |
|---|---|
| Speciality | Family Medicine |
| Location | 3495 S Center Rd, Burton, Michigan |
| Authorized Official Name and Position | Randolph Kummler (CEO) |
| Authorized Official Contact | 8104242025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ascension Medical Group Genesys 3495 S Center Rd Burton MI 48519-1455 Ph: (810) 424-2136 | Ascension Medical Group Genesys 3495 S Center Rd Burton MI 48519-1455 Ph: (810) 424-2136 |
| NPI Number | 1598248718 |
|---|---|
| Provider Enumeration Date | 09/13/2018 |
| Last Update Date | 08/18/2020 |
| Medicare PECOS PAC ID | 7214288281 |
|---|---|
| Medicare Enrollment ID | O20181002000367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598248718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Reese J James |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306871173 PECOS PAC ID: 8022922103 Enrollment ID: I20031113000379 |
| Provider Name | Salwan L Toma |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548279763 PECOS PAC ID: 7911805775 Enrollment ID: I20031230000738 |
| Provider Name | Edsa M Negussie |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821021486 PECOS PAC ID: 6800798273 Enrollment ID: I20040126000166 |
| Provider Name | James P Finch |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326019662 PECOS PAC ID: 8921900309 Enrollment ID: I20040126000236 |
| Provider Name | Mehran Salari |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043256407 PECOS PAC ID: 5092617472 Enrollment ID: I20040126000247 |
| Provider Name | Shawn K Conner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568564367 PECOS PAC ID: 0446153324 Enrollment ID: I20040128001042 |
| Provider Name | Charles P Ellsworth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780786707 PECOS PAC ID: 4981507662 Enrollment ID: I20040129000995 |
| Provider Name | Patrick C Chang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912009705 PECOS PAC ID: 5496648784 Enrollment ID: I20040202000972 |
| Provider Name | Dhiraj Bedi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225130198 PECOS PAC ID: 1355234675 Enrollment ID: I20040202001117 |
| Provider Name | Jonathan Arbogast |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326140906 PECOS PAC ID: 3577457407 Enrollment ID: I20040211001012 |
| Provider Name | Mark Schaaf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306932611 PECOS PAC ID: 6709771504 Enrollment ID: I20040219000922 |
| Provider Name | Steve Min |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861584674 PECOS PAC ID: 7113816075 Enrollment ID: I20040311000034 |
| Provider Name | Denis R Lincoln |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427094929 PECOS PAC ID: 4789665373 Enrollment ID: I20040719000344 |
| Provider Name | James E Selis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396769378 PECOS PAC ID: 4880675479 Enrollment ID: I20040719000419 |
| Provider Name | Roger L Gonda |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821032277 PECOS PAC ID: 0042291643 Enrollment ID: I20040719000638 |
| Provider Name | Teresa Sherman-gach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144245218 PECOS PAC ID: 3072593557 Enrollment ID: I20040723001162 |
| Provider Name | Dennis Pank |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326141102 PECOS PAC ID: 2062315237 Enrollment ID: I20041018000018 |
| Provider Name | Dirk W Snyder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679675342 PECOS PAC ID: 8820050149 Enrollment ID: I20041029000339 |
| Provider Name | Robert M Morley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902998719 PECOS PAC ID: 4880658962 Enrollment ID: I20041118000102 |
| Provider Name | Kasandra A Lechel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306954334 PECOS PAC ID: 0941245658 Enrollment ID: I20050623000067 |
| Provider Name | Thomas L Bossi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346342235 PECOS PAC ID: 6507801123 Enrollment ID: I20050623001041 |
| Provider Name | Brian J Puzsar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164468179 PECOS PAC ID: 9335177591 Enrollment ID: I20050728001134 |
| Provider Name | Bhagwan D Sayal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881796555 PECOS PAC ID: 3678507258 Enrollment ID: I20050922001010 |
| Provider Name | Gary A Mally |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770518367 PECOS PAC ID: 4183645377 Enrollment ID: I20051215000487 |
| Provider Name | James R Lum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093817751 PECOS PAC ID: 7113934654 Enrollment ID: I20060308000685 |
| Provider Name | Jaishree Tandon Sharma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982613915 PECOS PAC ID: 4981613189 Enrollment ID: I20060417000705 |
| Provider Name | Paul Chrenka |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780621292 PECOS PAC ID: 7214947456 Enrollment ID: I20060502000604 |
| Provider Name | Gerard K Surmann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588600464 PECOS PAC ID: 5890799464 Enrollment ID: I20060913000290 |
| Provider Name | Jennifer L Klock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801833975 PECOS PAC ID: 6507862687 Enrollment ID: I20061012000431 |
| Provider Name | Janan A Alkilidar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215031828 PECOS PAC ID: 1658318522 Enrollment ID: I20061024000407 |
| Provider Name | Nasser O Qadri |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1275616849 PECOS PAC ID: 1759380918 Enrollment ID: I20061215000459 |
| Provider Name | John N Storrer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710108741 PECOS PAC ID: 3274634423 Enrollment ID: I20070718000643 |
| Provider Name | Kevin W Youngs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366559361 PECOS PAC ID: 6204937188 Enrollment ID: I20070723000124 |
| Provider Name | Joseph Shull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568579613 PECOS PAC ID: 4385745272 Enrollment ID: I20070723000140 |
| Provider Name | Lorna Jean Hendricks |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710107875 PECOS PAC ID: 6709978018 Enrollment ID: I20070816000296 |
| Provider Name | Manisha Kia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780793893 PECOS PAC ID: 6709978901 Enrollment ID: I20070817000172 |
| Provider Name | Clarissa C Co |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659564789 PECOS PAC ID: 1951494103 Enrollment ID: I20070905000280 |
| Provider Name | Julie A Sawade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285847525 PECOS PAC ID: 9638265259 Enrollment ID: I20071012000249 |
| Provider Name | Murugusundaram Veeramani |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063438752 PECOS PAC ID: 2567411051 Enrollment ID: I20071025000089 |
| Provider Name | James D Walter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912009580 PECOS PAC ID: 3072698901 Enrollment ID: I20080317000307 |
| Provider Name | Theresa M Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407977200 PECOS PAC ID: 7810064227 Enrollment ID: I20080927000096 |
| Provider Name | Ariel C Ponce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164458592 PECOS PAC ID: 2264591494 Enrollment ID: I20081103000709 |
| Provider Name | Catherine E Deleeuw |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144486481 PECOS PAC ID: 1658421466 Enrollment ID: I20090616000481 |
| Provider Name | Macksood A Aftab |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124243282 PECOS PAC ID: 3375696149 Enrollment ID: I20090728000254 |
| Provider Name | Kavitha Baddam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790764553 PECOS PAC ID: 3971646548 Enrollment ID: I20100204000200 |
| Provider Name | Inderjit S Bhatti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659473544 PECOS PAC ID: 6103969688 Enrollment ID: I20100205000283 |
| Provider Name | Delia R Ebuen Mercado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629170444 PECOS PAC ID: 2769525260 Enrollment ID: I20100205000432 |
| Provider Name | Kelvin Callaway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689776577 PECOS PAC ID: 6103969613 Enrollment ID: I20100205000540 |
| Provider Name | Ayman E Tadros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205938974 PECOS PAC ID: 3375686892 Enrollment ID: I20100205000629 |
| Provider Name | Dale A Hanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346342086 PECOS PAC ID: 1355484874 Enrollment ID: I20100205000662 |
| Provider Name | Parmanand Khandelwal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104928845 PECOS PAC ID: 7618010133 Enrollment ID: I20100205000670 |
| Provider Name | Bill E Hukill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689776320 PECOS PAC ID: 3779628995 Enrollment ID: I20100226000496 |
| Provider Name | Mona Perry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508968264 PECOS PAC ID: 0547305773 Enrollment ID: I20100226000555 |
| Provider Name | Paul H Karr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114029857 PECOS PAC ID: 6901982263 Enrollment ID: I20100226000603 |
| Provider Name | Gerald A Fulton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891897633 PECOS PAC ID: 1557406709 Enrollment ID: I20100226000758 |
| Provider Name | Sean E Gilin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811099567 PECOS PAC ID: 6800931783 Enrollment ID: I20100303000340 |
| Provider Name | Ronald Coriasso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518069319 PECOS PAC ID: 8729123625 Enrollment ID: I20100303000547 |
| Provider Name | Christie L Samuels |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083716757 PECOS PAC ID: 6608911508 Enrollment ID: I20100303000585 |
| Provider Name | Douglas J Benton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730281619 PECOS PAC ID: 8820133739 Enrollment ID: I20100303000643 |
| Provider Name | Kevin T Snyder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578582391 PECOS PAC ID: 9739174715 Enrollment ID: I20100325000108 |
| Provider Name | John M Commet |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437178225 PECOS PAC ID: 9335134311 Enrollment ID: I20100325000133 |
| Provider Name | Kristin V Nikolakeas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336342799 PECOS PAC ID: 6608990890 Enrollment ID: I20100824001247 |
| Provider Name | Nedi Gari |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598887457 PECOS PAC ID: 7517149115 Enrollment ID: I20110302000951 |
| Provider Name | Paul S Czarnecki |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346351343 PECOS PAC ID: 3072795657 Enrollment ID: I20110303000779 |
| Provider Name | Kristen M Kurzeja |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922121540 PECOS PAC ID: 6002098688 Enrollment ID: I20110303000851 |
| Provider Name | Renee M Krusniak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396847042 PECOS PAC ID: 7810170107 Enrollment ID: I20110323001038 |
| Provider Name | George Arnold |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134333727 PECOS PAC ID: 8628255304 Enrollment ID: I20110606000591 |
| Provider Name | Alula K Kenfe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154512895 PECOS PAC ID: 9537338074 Enrollment ID: I20110817000835 |
| Provider Name | Katherine J Naber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881823573 PECOS PAC ID: 7315101599 Enrollment ID: I20120620000153 |
| Provider Name | Adrea L Gardner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003242397 PECOS PAC ID: 8729216627 Enrollment ID: I20140123001202 |
| Provider Name | Lodewijk Jules Van Holsbeeck |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285864272 PECOS PAC ID: 5193949196 Enrollment ID: I20140731000114 |
| Provider Name | Kristen Bentley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659740454 PECOS PAC ID: 7618286410 Enrollment ID: I20151019000407 |
| Provider Name | Ashley Duffield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215300033 PECOS PAC ID: 6709196348 Enrollment ID: I20151110002190 |
| Provider Name | April Fischer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669714077 PECOS PAC ID: 3375844996 Enrollment ID: I20151223001118 |
| Provider Name | Danielle M Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083082317 PECOS PAC ID: 5890091318 Enrollment ID: I20160309002681 |
| Provider Name | Rhonda J Morse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154778132 PECOS PAC ID: 3678864931 Enrollment ID: I20160617000369 |
| Provider Name | Ahmed M El-sabbagh |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1376917781 PECOS PAC ID: 0941502488 Enrollment ID: I20170224000488 |
| Provider Name | Diane Holmes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518341965 PECOS PAC ID: 1850678939 Enrollment ID: I20170426002699 |
| Provider Name | Karl F Kado |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497030233 PECOS PAC ID: 4880962927 Enrollment ID: I20170614001759 |
| Provider Name | Kathryn Gomane |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376938563 PECOS PAC ID: 6608145602 Enrollment ID: I20170707000522 |
| Provider Name | Ryan S Petty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902331598 PECOS PAC ID: 7911276928 Enrollment ID: I20170707000683 |
| Provider Name | Foaz Kayali |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1871882365 PECOS PAC ID: 5597020354 Enrollment ID: I20180525001147 |
| Provider Name | Michael W Warren |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1700140068 PECOS PAC ID: 7911254396 Enrollment ID: I20180716003509 |
| Provider Name | Stephanie Alexandra Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528558962 PECOS PAC ID: 8820349293 Enrollment ID: I20180924002789 |
| Provider Name | Joseph Simmert |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124120894 PECOS PAC ID: 6709138944 Enrollment ID: I20181016002647 |
| Provider Name | Esther Benigna Lehmann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578902441 PECOS PAC ID: 2668601626 Enrollment ID: I20190404000204 |
| Provider Name | Rani Bashiti |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083052377 PECOS PAC ID: 6608100417 Enrollment ID: I20190627003497 |
| Provider Name | Eric K Rinker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396087797 PECOS PAC ID: 8527291988 Enrollment ID: I20190725001207 |
| Provider Name | Laura Hinman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285080838 PECOS PAC ID: 6608164280 Enrollment ID: I20190806000155 |
| Provider Name | Teresa Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699328443 PECOS PAC ID: 2365770450 Enrollment ID: I20190828000628 |
| Provider Name | Matthew W Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154314029 PECOS PAC ID: 6709982606 Enrollment ID: I20191030000526 |
| Provider Name | Eric M Nowicki |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922492289 PECOS PAC ID: 7719302066 Enrollment ID: I20200803002062 |
| Provider Name | Dominic Maffetone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164950341 PECOS PAC ID: 4486925559 Enrollment ID: I20200803003165 |
| Provider Name | Julie Ballard |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1649898487 PECOS PAC ID: 6901221894 Enrollment ID: I20200810002012 |
| Provider Name | Nathan R Hamilton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912431776 PECOS PAC ID: 6800167974 Enrollment ID: I20200825002899 |
| Provider Name | Khaled Hammoud |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174962187 PECOS PAC ID: 1456582212 Enrollment ID: I20201117000293 |
| Provider Name | Christopher Russell Hammer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871997437 PECOS PAC ID: 0749402261 Enrollment ID: I20201207000145 |
| Provider Name | Marguerite Goodroe |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194224097 PECOS PAC ID: 3577963503 Enrollment ID: I20210614001891 |
| Provider Name | Jamie Lynn Qualls |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619404746 PECOS PAC ID: 7719305234 Enrollment ID: I20210809002115 |
| Provider Name | Diana Stanek |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447929971 PECOS PAC ID: 4587060868 Enrollment ID: I20210913000739 |
| Provider Name | Mary C Warren |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770085227 PECOS PAC ID: 0941695845 Enrollment ID: I20220310002830 |
| Provider Name | Jeremy Zuba |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427482272 PECOS PAC ID: 4082087978 Enrollment ID: I20230223000891 |
| Provider Name | Nathan A Seibold |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215433743 PECOS PAC ID: 2062886609 Enrollment ID: I20230321002305 |
| Provider Name | Anne M Mccall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386349678 PECOS PAC ID: 4587013206 Enrollment ID: I20231206004132 |
Shukairy P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 S Center Rd Bldg B, Burton, MI 48509 Phone: 810-742-0225 Fax: 810-742-7990 | |
Genesys Integrated Group Practice Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3495 S Center Rd, Burton, MI 48519 Phone: 810-424-2007 Fax: 810-232-2266 | |
Learning Dreams Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1091 Creekwood Trl, Burton, MI 48509 Phone: 810-391-2923 Fax: 810-391-2968 | |
Tommy S. Stevens M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2298 S Center Rd, Burton, MI 48519 Phone: 810-742-2544 Fax: 810-742-2566 | |
M. Haitham Al-midani, Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4050 Walli Strasse Dr, Burton, MI 48509 Phone: 810-743-0680 | |
Dr Mark P Williams Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4067 E Court St # 10-11, Burton, MI 48509 Phone: 810-715-2020 | |
Ascension Medical Group Genesys Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3495 S Center Rd, Burton, MI 48519 Phone: 810-424-2136 Fax: 810-249-4149 |