Great Lakes Physicians Of Redford,p.l.l.c.

NPI 1063682730 - Internal Medicine - 207R00000X

NPI Details
NPI 1063682730
Enumeration Date 03/09/2008
Last Updated 03/09/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name MUSTAK Y MUSTAK
Position SOLO OWNER
Phone (313) 538-1800
Fax (313) 538-9082
Practice Location
25321 5 MILE RD
SUITE # 1
REDFORD MI, 48239-3700, US
Phone (313) 538-1800
Fax (313) 538-9082
Business Location
23300 PROVIDENCE DR
SUITE # 104
SOUTHFIELD MI, 48075-3652, US
Phone (248) 996-8777
Fax (248) 996-8778
Toxanomy
Taxonomy Code 207R00000X
License State Michigan
License Number 1630863
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According to our database, Great Lakes Physicians Of Redford,p.l.l.c. NPI is 1063682730, taxonomy code is 207R00000X and license number is 1630863, license state is located at Michigan. Great Lakes Physicians Of Redford,p.l.l.c. physically located at 25321 5 Mile Rd, Redford MI, 48239-3700. NPI Number 1033115704 has the healthcare provider type.

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1063682730 NPI number is provided on an as is basis without warranty of any kind. 1063682730 is maintained by the National Plan & Provider Enumeration System. The contents of Great Lakes Physicians Of Redford,p.l.l.c. are for informational purposes only.