1871673962 NPI number — ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, P.C.

Table of content: (NPI 1871673962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871673962 NPI number — ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, 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:
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:
1871673962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20952 E 12 MILE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48081-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-771-4820
Provider Business Mailing Address Fax Number:
586-771-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18100 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-4085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-271-0066
Provider Business Practice Location Address Fax Number:
313-271-1047
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCAULEY
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CREDENTIALER
Authorized Official Telephone Number:
586-771-4820

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2088P0231X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 340E062730 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540E016120 . This is a "BCBSM DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CB9133 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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