| Kancc Medical | |
|
17331 Mack Ave Detroit MI 48224-2250 | |
| (313) 473-8525 | |
| (313) 473-8521 |
| Full Name | Kancc Medical |
|---|---|
| Speciality | General Practice |
| Location | 17331 Mack Ave, Detroit, Michigan |
| Authorized Official Name and Position | Peter R Nwoke (OWNER) |
| Authorized Official Contact | 3134738525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kancc Medical Po Box 806464 Saint Clair Shores MI 48080-6464 Ph: (313) 473-8525 | Kancc Medical 17331 Mack Ave Detroit MI 48224-2250 Ph: (313) 473-8525 |
| NPI Number | 1437710563 |
|---|---|
| Provider Enumeration Date | 06/28/2019 |
| Last Update Date | 07/18/2022 |
| Medicare PECOS PAC ID | 1850760877 |
|---|---|
| Medicare Enrollment ID | O20221214002712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437710563 | NPI | - | NPPES |
| Provider Name | Peter R Nwoke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841398955 PECOS PAC ID: 9638176373 Enrollment ID: I20061023000253 |
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