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20755 Greenfield Rd Suite #203 Southfield MI 48075-5403 | |
| (248) 395-2206 | |
| (248) 395-0456 |
| Full Name | |
|---|---|
| Speciality | Specialist/technologist, Other - Nephrology |
| Location | 20755 Greenfield Rd, Southfield, Michigan |
| Authorized Official Name and Position | Boniface Atakekor Tubie (PHYSICIAN/ CEO) |
| Authorized Official Contact | 2483952206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6915 Dobbs Way West Bloomfield MI 48322-3077 Ph: (248) 592-1518 | 20755 Greenfield Rd Suite #203 Southfield MI 48075-5403 Ph: (248) 395-2206 |
| NPI Number | 1912001314 |
|---|---|
| Provider Enumeration Date | 09/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912001314 | NPI | - | NPPES |
| 4341231 | Medicaid | MI |
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