| Imhotep Medical Services, Inc. | |
|
5525 Greenway St Detroit MI 48204-2112 | |
| (313) 935-0399 | |
| (313) 931-9113 |
| Full Name | Imhotep Medical Services, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 5525 Greenway St, Detroit, Michigan |
| Authorized Official Name and Position | Connie L Mitchell (OWNER, PHYSICIAN) |
| Authorized Official Contact | 3137011187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imhotep Medical Services, Inc. 5525 Greenway St Suite B - 2 Detroit MI 48204-2112 Ph: (313) 701-1187 | Imhotep Medical Services, Inc. 5525 Greenway St Detroit MI 48204-2112 Ph: (313) 935-0399 |
| NPI Number | 1386767473 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 10/06/2014 |
| Medicare PECOS PAC ID | 1658349550 |
|---|---|
| Medicare Enrollment ID | O20040920000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386767473 | NPI | - | NPPES |
| 4706980 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M4301056553 (Michigan) | Primary |
| Provider Name | Connie L Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710097019 PECOS PAC ID: 9931004173 Enrollment ID: I20031202000091 |
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