| Grace University Medical Group | |
|
6071 W Outer Dr Dept Of Medicine 4th Floor Detroit MI 48235-2624 | |
| (313) 966-4946 | |
| Not Available |
| Full Name | Grace University Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 6071 W Outer Dr, Detroit, Michigan |
| Authorized Official Name and Position | Kenneth Bergsman (MANAGER) |
| Authorized Official Contact | 3139664946 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace University Medical Group Po Box 321061 Detroit MI 48232-1061 Ph: (248) 543-8070 | Grace University Medical Group 6071 W Outer Dr Dept Of Medicine 4th Floor Detroit MI 48235-2624 Ph: (313) 966-4946 |
| NPI Number | 1447215538 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 09/19/2007 |
| Medicare PECOS PAC ID | 2769463397 |
|---|---|
| Medicare Enrollment ID | O20040528000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447215538 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | 4301028293 (Michigan) | Secondary |
| Provider Name | Lalitha Koneru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356569644 PECOS PAC ID: 1254328743 Enrollment ID: I20040427001213 |
| Provider Name | Joel L Appel |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1811935273 PECOS PAC ID: 8729076542 Enrollment ID: I20040503000153 |
| Provider Name | Carol P Appel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053370551 PECOS PAC ID: 5799753844 Enrollment ID: I20040917000286 |
| Provider Name | Ramya Manney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548603863 PECOS PAC ID: 8022319698 Enrollment ID: I20180430002484 |
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