| Virginia Park Internal Medicine Pc | |
|
8500 14th St Detroit MI 48206-2425 | |
| (313) 894-3950 | |
| (313) 894-1729 |
| Full Name | Virginia Park Internal Medicine Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8500 14th St, Detroit, Michigan |
| Authorized Official Name and Position | Joseph N Hagen (PRESIDENT/ REGISTERED AGENT) |
| Authorized Official Contact | 3138943950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virginia Park Internal Medicine Pc 8500 14th St Detroit MI 48206-2425 Ph: (313) 894-3950 | Virginia Park Internal Medicine Pc 8500 14th St Detroit MI 48206-2425 Ph: (313) 894-3950 |
| NPI Number | 1861829343 |
|---|---|
| Provider Enumeration Date | 09/30/2013 |
| Last Update Date | 09/30/2013 |
| Medicare PECOS PAC ID | 8426287079 |
|---|---|
| Medicare Enrollment ID | O20140131001090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861829343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Joseph N Hagen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811989650 PECOS PAC ID: 9739173543 Enrollment ID: I20040414000167 |
| Provider Name | Chidimma A Onwuegbuchu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235704222 PECOS PAC ID: 4284032228 Enrollment ID: I20211006001027 |
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