| Medical Group Practice, P.c. | |
|
9460 Middlebelt Rd Livonia MI 48150-3059 | |
| (734) 425-0500 | |
| (734) 425-1002 |
| Full Name | Medical Group Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 9460 Middlebelt Rd, Livonia, Michigan |
| Authorized Official Name and Position | William P Penn (OWNER) |
| Authorized Official Contact | 7344250500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Group Practice, P.c. 9460 Middlebelt Rd Livonia MI 48150-3059 Ph: (734) 425-0500 | Medical Group Practice, P.c. 9460 Middlebelt Rd Livonia MI 48150-3059 Ph: (734) 425-0500 |
| NPI Number | 1801925201 |
|---|---|
| Provider Enumeration Date | 03/04/2007 |
| Last Update Date | 06/08/2009 |
| Medicare PECOS PAC ID | 7416007398 |
|---|---|
| Medicare Enrollment ID | O20090616000112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801925201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101005940 (Michigan) | Primary |
| 207Q00000X | Family Medicine | 5101004910 (Michigan) | Secondary |
| Provider Name | William P Penn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740287812 PECOS PAC ID: 8224188115 Enrollment ID: I20100618000806 |
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