| Mmg 1pc | |
|
7419 Middlebelt Rd Suite 4 West Bloomfield MI 48322-4182 | |
| (248) 855-2291 | |
| (248) 855-4901 |
| Full Name | Mmg 1pc |
|---|---|
| Speciality | Family Medicine |
| Location | 7419 Middlebelt Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Geoffrey A Trivax (PRESIDENT) |
| Authorized Official Contact | 3135383099 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mmg 1pc 29992 Northwestern Hwy Ste C Farmington Hills MI 48334-3292 Ph: (248) 851-1430 | Mmg 1pc 7419 Middlebelt Rd Suite 4 West Bloomfield MI 48322-4182 Ph: (248) 855-2291 |
| NPI Number | 1205855186 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 09/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205855186 | NPI | - | NPPES |
| 700F321510 | Other | MI | BLUE SHIELD GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Secondary |
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