1992999080 NPI number — MOTOR CITY INTERNISTS

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 1992999080 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:
1992999080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25925 TELEGRAPH RD
Provider Second Line Business Mailing Address:
210
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-746-3218
Provider Business Mailing Address Fax Number:
248-746-0369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7633 E JEFFERSON AVE
Provider Second Line Business Practice Location Address:
260
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48214-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-331-2650
Provider Business Practice Location Address Fax Number:
313-331-2690
Provider Enumeration Date:
08/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITMAN
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
248-746-5822

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)