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20041 West Eight Mile Road North Clinic, P.c. Detroit MI 48219 | |
| (313) 532-5030 | |
| (313) 532-0552 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 20041 West Eight Mile Road, Detroit, Michigan |
| Authorized Official Name and Position | Peter H. Gaggos (PRESIDENT) |
| Authorized Official Contact | 3135325030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
20041 West Eight Mile Road North Clinic, P.c. Detroit MI 48219 Ph: (313) 532-5030 | 20041 West Eight Mile Road North Clinic, P.c. Detroit MI 48219 Ph: (313) 532-5030 |
| NPI Number | 1992033864 |
|---|---|
| Provider Enumeration Date | 12/03/2009 |
| Last Update Date | 12/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992033864 | NPI | - | NPPES |
| 1025621 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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