1881635241 NPI number — MOTOR CITY INTERNISTS

Table of content: (NPI 1881635241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881635241 NPI number — MOTOR CITY INTERNISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOTOR CITY INTERNISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881635241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7633 E JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48214-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-331-2650
Provider Business Mailing Address Fax Number:
313-331-2690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25925 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-746-3218
Provider Business Practice Location Address Fax Number:
313-746-0369
Provider Enumeration Date:
06/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEVAN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-365-9740

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)