| Pai Participant 18 Pc | |
|
18200 W 13 Mile Rd Beverly Hills MI 48025-5446 | |
| (314) 761-5764 | |
| Not Available |
| Full Name | Pai Participant 18 Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18200 W 13 Mile Rd, Beverly Hills, Michigan |
| Authorized Official Name and Position | Erin Laird (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 18 Pc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 18 Pc 18200 W 13 Mile Rd Beverly Hills MI 48025-5446 Ph: (314) 761-5764 |
| NPI Number | 1750988226 |
|---|---|
| Provider Enumeration Date | 10/07/2020 |
| Last Update Date | 10/07/2020 |
| Medicare PECOS PAC ID | 6204256928 |
|---|---|
| Medicare Enrollment ID | O20201020000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750988226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Jerome Wilborn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750351516 PECOS PAC ID: 2163412834 Enrollment ID: I20040913000586 |
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