| Changhee Kim Md Phd Plc | |
|
38815 Dequindre Rd Suite 103 Troy MI 48083-6810 | |
| (248) 740-7771 | |
| Not Available |
| Full Name | Changhee Kim Md Phd Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 38815 Dequindre Rd, Troy, Michigan |
| Authorized Official Name and Position | Changhee Kim (OWNER) |
| Authorized Official Contact | 2487407771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changhee Kim Md Phd Plc 38815 Dequindre Rd Suite 103 Troy MI 48083-6810 Ph: (248) 740-7771 | Changhee Kim Md Phd Plc 38815 Dequindre Rd Suite 103 Troy MI 48083-6810 Ph: (248) 740-7771 |
| NPI Number | 1790963171 |
|---|---|
| Provider Enumeration Date | 02/07/2008 |
| Last Update Date | 02/28/2008 |
| Medicare PECOS PAC ID | 5597652974 |
|---|---|
| Medicare Enrollment ID | O20040301000988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790963171 | NPI | - | NPPES |
| 4562401 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301059643 (Michigan) | Primary |
| Provider Name | Changhee Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215918479 PECOS PAC ID: 7012804487 Enrollment ID: I20040301000949 |
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