PROMEDICA CORPORATION OF MICHIGAN (NPI# 1093840381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093840381 |
| Entity Type | Organization |
| Organization Name | PROMEDICA CORPORATION OF MICHIGAN |
| Other Organization Name | ADRIAN SURGICAL ASSOICATES |
| Practice Address |
777 Kimole Ln Suite 220 Adrian MI 49221-1478 |
| Practice Telephone | 5172636464 |
| Practice Fax Number | 5172638223 |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | KIMBERLY GOVA (CREDENTIALING ASST) |
| Authorized Official Telephone | 4198247221 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | ========= | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | RRMC | CD9268 | 01 |
| OH | 2002924 | 05 |
| Other Name | Type Code |
|---|---|
| Adrian Surgical Assoicates | 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 220 |
| 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 |
| 1336276542 | Promedica Corporation of Michigan | Otolaryngology | 777 Kimole Ln, Suite 240, Adrian, MI 49221-1478 | 2007-02-27 |
| 1255483038 | Toledo Clinic Incorporated | Durable Medical Equipment & Medical Supplies | 777 Kimole Ln, Suite 130, Adrian, MI 49221-1478 | 2007-01-18 |
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| 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 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649478538 | Matthew Thomas Keibler | Surgery | 777 Kimole Ln Ste 220, Adrian, MI 49221-1400 | 2007-07-03 |
| 1669489258 | Abdul G Arshad | Surgery | 750 High St, Adrian, MI 49221-1443 | 2006-08-03 |
| 1609903814 | Promedica Corporation of Michigan | Surgery | 750 High St, Adrian, MI 49221-1443 | 2007-02-27 |
| 1487662797 | Donald J Martin Jr. | Surgery | 750 High St, Adrian, MI 49221-1443 | 2006-08-03 |
| 1982606877 | Richard G Girardi | Surgery | 777 Kimole Ln, Suite 220, Adrian, MI 49221-1478 | 2005-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508475237 | Dr Dayhim Pllc | Surgery | 12203 Shearwater Cir, Commerce Township, MI 48390-4260 | 2020-07-28 |
| 1922624923 | Dr Anthony Joseph Md Pllc | Surgery | 2330 S Milford Rd Ste 120, Highland, MI 48357-4982 | 2020-06-25 |
| 1316563646 | Shelley Gabel | Surgery | 1200 E Michigan Ave., Sparrow Professional Building Suite 655, Lansing, MI 48912 | 2020-06-23 |
| 1922623081 | Joon B Kim | Surgery | 1200 Michigan Ave Ste 655, East Lansing, MI 48823-4099 | 2020-06-14 |
| 1932724101 | Alec Jerry Raniwsky | Surgery | 22250 Providence Drive 7pmb Suite #703a, Southfield, MI 48075-4825 | 2020-06-12 |
| 1184245771 | Upper Michigan Associates LLC | Surgery | 1414 W Fair Ave Ste 235, Marquette, MI 49855-5406 | 2020-05-05 |
| 1245851427 | Adriana Sharp | Surgery | 1 Genesys, Grand Blanc, MI 48439 | 2020-04-29 |
| 1487275509 | Erika C Michelin | Surgery | 28080 Grand River Ave Ste 208, Farmington Hills, MI 48336-5966 | 2020-04-29 |
| 1063047629 | Suzanne A. Law, D.o., P.C. | Surgery | G4007 W Court St Ste E, Flint, MI 48532-3560 | 2020-03-04 |
| 1801454871 | Dakita Mack | Surgery | 28050 Grand River Ave Ste 208n, Farmington Hills, MI 48336-5919 | 2019-06-04 |
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| 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.