| Johanna J Verwilghen Md Pllc | |
|
4160 John R St Suite 525 Detroit MI 48201-2020 | |
| (313) 831-1100 | |
| (313) 831-1177 |
| Full Name | Johanna J Verwilghen Md Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4160 John R St, Detroit, Michigan |
| Authorized Official Name and Position | Johanna Jacoba Verwilghen (OFFICE MANAGER) |
| Authorized Official Contact | 3138311100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johanna J Verwilghen Md Pllc 4160 John R St Suite 525 Detroit MI 48201-2020 Ph: (313) 831-1100 | Johanna J Verwilghen Md Pllc 4160 John R St Suite 525 Detroit MI 48201-2020 Ph: (313) 831-1100 |
| NPI Number | 1700054210 |
|---|---|
| Provider Enumeration Date | 02/19/2008 |
| Last Update Date | 01/14/2013 |
| Medicare PECOS PAC ID | 5991762833 |
|---|---|
| Medicare Enrollment ID | O20041213000772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700054210 | NPI | - | NPPES |
| 1108235412 | Other | MI | BCBS |
| 1108235412 | Other | MI | BSBC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301077528 (Michigan) | Primary |
| Provider Name | Johanna J Verwilghen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316987142 PECOS PAC ID: 4880651728 Enrollment ID: I20041214000090 |
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