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NPI Code Detail

MEDICARE: DETROIT - 8 MILE P.C.

MEDICARE: DETROIT - 8 MILE P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1205019924
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETROIT - 8 MILE P.C.
Provider Business Mailing Address
First Line : 511 W 8 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48203-1004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 511 W 8 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48203-1004
Country : US
Telephone Number : 313-891-7330
Fax Number :
Authorized Official
Title or Position : INSURANCE DIRECTOR
Name : MIKE COLE
Credential :
Telephone Number : 727-726-1611
Provider Enumeration Date : 12/17/2007
Last Update Date : 12/17/2007

Similar Medicare Providers

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1821482829 — DRJ OF EIGHT MILE PLLC
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Directions to “DETROIT - 8 MILE P.C. ” Practice Location

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