| The Village Doctor At Cherry Hill | |
|
50439 Independence St Canton MI 48188-6735 | |
| (734) 879-1068 | |
| Not Available |
| Full Name | The Village Doctor At Cherry Hill |
|---|---|
| Speciality | Family Medicine |
| Location | 50439 Independence St, Canton, Michigan |
| Authorized Official Name and Position | Kenneth J Grimm (MEMBER) |
| Authorized Official Contact | 7346459228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Village Doctor At Cherry Hill 49796 Taft Ln Canton MI 48188-6722 Ph: (734) 645-9228 | The Village Doctor At Cherry Hill 50439 Independence St Canton MI 48188-6735 Ph: (734) 879-1068 |
| NPI Number | 1629348792 |
|---|---|
| Provider Enumeration Date | 01/06/2012 |
| Last Update Date | 07/05/2012 |
| Medicare PECOS PAC ID | 7214192640 |
|---|---|
| Medicare Enrollment ID | O20120709000733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629348792 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kenneth Grimm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215916101 PECOS PAC ID: 2961486576 Enrollment ID: I20040614000228 |
| Provider Name | Sara West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265858500 PECOS PAC ID: 1759513260 Enrollment ID: I20140416001183 |
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