| Alsan Medical Clinic P.c. | |
|
3130 Gratiot Ave Detroit MI 48207-2283 | |
| (313) 579-1860 | |
| (313) 579-0017 |
| Full Name | Alsan Medical Clinic P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 3130 Gratiot Ave, Detroit, Michigan |
| Authorized Official Name and Position | Jacqueline Graham (OFFICE MANAGER) |
| Authorized Official Contact | 3135791860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alsan Medical Clinic P.c. 3130 Gratiot Ave Detroit MI 48207-2283 Ph: (313) 579-1860 | Alsan Medical Clinic P.c. 3130 Gratiot Ave Detroit MI 48207-2283 Ph: (313) 579-1860 |
| NPI Number | 1235352345 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 05/26/2010 |
| Medicare PECOS PAC ID | 9830127463 |
|---|---|
| Medicare Enrollment ID | O20050803000742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235352345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Christina L Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467515171 PECOS PAC ID: 9638107220 Enrollment ID: I20050804000080 |
| Provider Name | Frank M Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831105782 PECOS PAC ID: 8820900996 Enrollment ID: I20101213000952 |
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