| Park Place Family Practice & Internal Medicine | |
|
12701 Telegraph Rd Ste 103 Taylor MI 48180-4087 | |
| (734) 374-0500 | |
| (734) 374-2415 |
| Full Name | Park Place Family Practice & Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 12701 Telegraph Rd Ste 103, Taylor, Michigan |
| Authorized Official Name and Position | Susan Goswami (OFFICE ADMIN) |
| Authorized Official Contact | 7343740500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Place Family Practice & Internal Medicine 12701 Telegraph Rd Ste 103 Taylor MI 48180-4087 Ph: (734) 374-0500 | Park Place Family Practice & Internal Medicine 12701 Telegraph Rd Ste 103 Taylor MI 48180-4087 Ph: (734) 374-0500 |
| NPI Number | 1891307443 |
|---|---|
| Provider Enumeration Date | 08/17/2020 |
| Last Update Date | 07/21/2021 |
| Medicare PECOS PAC ID | 4880012657 |
|---|---|
| Medicare Enrollment ID | O20200910000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891307443 | NPI | - | NPPES |
| OH62264 | Other | MI | BCBSM PIN |
| 1891307443 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ramsewak S Goswami |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679544415 PECOS PAC ID: 1355319294 Enrollment ID: I20040920000951 |
| Provider Name | Raj A Goswami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952372799 PECOS PAC ID: 7618911272 Enrollment ID: I20050614001174 |
| Provider Name | Leah Kristine Amorose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073172326 PECOS PAC ID: 3274862404 Enrollment ID: I20190912001536 |
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