| Provider Service Organization | |
|
7233 Provincial Ct Canton MI 48187-2121 | |
| (734) 516-4239 | |
| (734) 404-5292 |
| Full Name | Provider Service Organization |
|---|---|
| Speciality | Family Medicine - Geriatric Medicine |
| Location | 7233 Provincial Ct, Canton, Michigan |
| Authorized Official Name and Position | Ramon Villanueva (PRESIDENT) |
| Authorized Official Contact | 7345164239 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provider Service Organization 7233 Provincial Ct Canton MI 48187-2121 Ph: (734) 516-4239 | Provider Service Organization 7233 Provincial Ct Canton MI 48187-2121 Ph: (734) 516-4239 |
| NPI Number | 1447610704 |
|---|---|
| Provider Enumeration Date | 02/29/2016 |
| Last Update Date | 06/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447610704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
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