| Funderburg Ccs | |
|
25438 Saint James Southfield MI 48075-1247 | |
| (248) 809-9105 | |
| (248) 659-1528 |
| Full Name | Funderburg Ccs |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 25438 Saint James, Southfield, Michigan |
| Authorized Official Name and Position | Gerald Roderick Funderburg (OWNER) |
| Authorized Official Contact | 2488099105 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Funderburg Ccs 25438 Saint James Southfield MI 48075-1247 Ph: (248) 809-9105 | Funderburg Ccs 25438 Saint James Southfield MI 48075-1247 Ph: (248) 809-9105 |
| NPI Number | 1225254279 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 09/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225254279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801086140 (Michigan) | Primary |
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