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10 Peterboro St Detroit MI 48201-2722 | |
| (313) 831-3160 | |
| (313) 833-2604 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Peterboro St, Detroit, Michigan |
| Authorized Official Name and Position | Michelle Riley (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3132218595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10 Peterboro St Detroit MI 48201-2722 Ph: (313) 831-3160 | 10 Peterboro St Detroit MI 48201-2722 Ph: (313) 831-3160 |
| NPI Number | 1285043406 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 07/11/2024 |
| Medicare PECOS PAC ID | 3274728829 |
|---|---|
| Medicare Enrollment ID | O20101109001334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285043406 | NPI | - | NPPES |
| 1285043406 | Medicaid | MI |
| Provider Name | Del Charbonier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821198003 PECOS PAC ID: 3375501703 Enrollment ID: I20041230000707 |
| Provider Name | Hanheung Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477572469 PECOS PAC ID: 7214823020 Enrollment ID: I20050128000448 |
| Provider Name | Gregory Scott Washington |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568679314 PECOS PAC ID: 6800966268 Enrollment ID: I20080528000658 |
| Provider Name | Norris C Polk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841445640 PECOS PAC ID: 5597812388 Enrollment ID: I20090414000366 |
| Provider Name | Kimberly M Farrow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982930038 PECOS PAC ID: 5294983110 Enrollment ID: I20120919000329 |
| Provider Name | Marcy Binford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629479498 PECOS PAC ID: 9638399876 Enrollment ID: I20141009002235 |
| Provider Name | Augustina C Amadi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699886135 PECOS PAC ID: 1153643770 Enrollment ID: I20141209001450 |
| Provider Name | Robert J Huston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639577448 PECOS PAC ID: 0840597027 Enrollment ID: I20160404000449 |
| Provider Name | Dequanna Latrice Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457714974 PECOS PAC ID: 3476852096 Enrollment ID: I20160504000470 |
| Provider Name | Michele Monette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295277267 PECOS PAC ID: 9032499892 Enrollment ID: I20161213002165 |
| Provider Name | Deidre S Alford |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831235654 PECOS PAC ID: 5193024552 Enrollment ID: I20170310001840 |
| Provider Name | Renee Herrmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689183287 PECOS PAC ID: 4587920590 Enrollment ID: I20171108000203 |
| Provider Name | Erin Fecteau Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922441708 PECOS PAC ID: 3173824877 Enrollment ID: I20180724000115 |
| Provider Name | Cheryl A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265741789 PECOS PAC ID: 9436407491 Enrollment ID: I20180807003527 |
| Provider Name | Najibah K Rehman |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1346668829 PECOS PAC ID: 4284987546 Enrollment ID: I20181102001457 |
| Provider Name | Edith N Ama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558835868 PECOS PAC ID: 1254744568 Enrollment ID: I20210106000203 |
| Provider Name | Beatrice Krutel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346817640 PECOS PAC ID: 7911381108 Enrollment ID: I20220907003607 |
| Provider Name | Kywona Danielle Bernard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427641109 PECOS PAC ID: 2769840750 Enrollment ID: I20230623000664 |
| Provider Name | Tiffany N Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932792843 PECOS PAC ID: 2567823115 Enrollment ID: I20230731001633 |
| Provider Name | Melanie Odeleye |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1184988255 PECOS PAC ID: 0244474633 Enrollment ID: I20231002002678 |
| Provider Name | Polly Ann Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437594652 PECOS PAC ID: 8729433107 Enrollment ID: I20231005001840 |
| Provider Name | Marva Michelene Morton-neely |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1669684692 PECOS PAC ID: 7416398326 Enrollment ID: I20240509001868 |
| Provider Name | Young Shin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1104256015 PECOS PAC ID: 1254676356 Enrollment ID: I20240515001564 |
| Provider Name | Nicole Claudin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407238694 PECOS PAC ID: 4284025453 Enrollment ID: I20240517001820 |
| Provider Name | Karla Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619743606 PECOS PAC ID: 1850733429 Enrollment ID: I20240528003368 |
| Provider Name | Le'shay Webb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316305873 PECOS PAC ID: 2860935293 Enrollment ID: I20240613003699 |
| Provider Name | Lijin Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518707199 PECOS PAC ID: 6800330150 Enrollment ID: I20240627003906 |
| Provider Name | Shatangela Gibbs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013574037 PECOS PAC ID: 3577008713 Enrollment ID: I20240712000757 |
| Provider Name | Lauren Elizabeth Langton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770348583 PECOS PAC ID: 8123564572 Enrollment ID: I20240723000316 |
| Provider Name | Brandi Denise Sykes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689034324 PECOS PAC ID: 8628516127 Enrollment ID: I20240815000834 |
| Provider Name | Jerel N Owens |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1841303765 PECOS PAC ID: 2860712825 Enrollment ID: I20241025003815 |
| Provider Name | Olivia Hunter Croom |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1407927304 PECOS PAC ID: 2264966290 Enrollment ID: I20241113000436 |
| Provider Name | Rachel Whitney Nestor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154069458 PECOS PAC ID: 6406381649 Enrollment ID: I20241125000863 |
| Provider Name | Christopher Urbanik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093415523 PECOS PAC ID: 6305371386 Enrollment ID: I20241127002709 |
St. John Hospital And Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22101 Moross Rd, Detroit, MI 48236 Phone: 586-753-0011 | |
Health Care Medical Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17141 Hayes St, Detroit, MI 48205 Phone: 313-245-1700 Fax: 313-245-1701 | |
Mizrahi Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7633 E Jefferson Ave Ste 250, Detroit, MI 48214 Phone: 313-821-3338 Fax: 313-823-5363 | |
T L Sea Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15201 W Mcnichols Rd, Detroit, MI 48235 Phone: 313-516-3142 |