| Great Lakes Physicians Of Redford,p.l.l.c. | |
|
25321 5 Mile Rd Suite # 1 Redford MI 48239-3700 | |
| (313) 538-1800 | |
| (313) 538-9082 |
| Full Name | Great Lakes Physicians Of Redford,p.l.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 25321 5 Mile Rd, Redford, Michigan |
| Authorized Official Name and Position | Mustak Y Vaid (SOLO OWNER) |
| Authorized Official Contact | 2489968777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Physicians Of Redford,p.l.l.c. 23300 Providence Dr Suite # 104 Southfield MI 48075-3652 Ph: (248) 996-8777 | Great Lakes Physicians Of Redford,p.l.l.c. 25321 5 Mile Rd Suite # 1 Redford MI 48239-3700 Ph: (313) 538-1800 |
| NPI Number | 1063682730 |
|---|---|
| Provider Enumeration Date | 03/09/2008 |
| Last Update Date | 03/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063682730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 1630863 (Michigan) | Primary |
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