1518212240 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS PC

Table of content: (NPI 1518212240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518212240 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN HEALTHCARE PROFESSIONALS PC
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:
6
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:
1518212240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3577 W 13 MILE RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48073-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-288-4500
Provider Business Mailing Address Fax Number:
248-288-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 INVESTMENT DR
Provider Second Line Business Practice Location Address:
SUITE B120
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48098-6363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-267-6569
Provider Business Practice Location Address Fax Number:
248-267-6852
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARGOLIS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-851-1430

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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