1700667334 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700667334 NPI number — MICHIGAN HEALTHCARE PROFESSIONALS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN HEALTHCARE PROFESSIONALS, P.C.
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:
1700667334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29992 NORTHWESTERN HWY STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-3292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-851-1430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 E WARWICK DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48801-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-463-2150
Provider Business Practice Location Address Fax Number:
989-466-5392
Provider Enumeration Date:
10/10/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GLASSER
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
ASSUNTA
Authorized Official Title or Position:
CPA
Authorized Official Telephone Number:
248-851-3300

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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