| |
46156 Woodward Ave Pontiac MI 48342-5033 | |
(248) 897-0900 | |
(248) 858-6499 |
Full Name | |
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Speciality | Clinic/Center |
Location | 46156 Woodward Ave, Pontiac, Michigan |
Authorized Official Name and Position | Anthony V King (CEO & EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3132028550 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7700 2nd Ave Detroit MI 48202-2477 Ph: (313) 202-8660 | 46156 Woodward Ave Pontiac MI 48342-5033 Ph: (248) 897-0900 |
NPI Number | 1235651381 |
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Provider Enumeration Date | 07/11/2017 |
Last Update Date | 08/13/2020 |
Certification Date | 08/13/2020 |
Medicare PECOS PAC ID | 1052380201 |
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Medicare Enrollment ID | O20170922000012 |
Identifier | Type | State | Issuer |
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1235651381 | NPI | - | NPPES |
PENDING | Other | MI | PER WPS |
1235651381 | Other | PER WPS |
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