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NPI Code Detail

MEDICARE: OUTER DRIVE PARTNERS LLC

MEDICARE: OUTER DRIVE PARTNERS LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109999OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477550564
Entity Type Code : Organization
Provider Name (Legal Business Name) : OUTER DRIVE PARTNERS LLC
Provider Business Mailing Address
First Line : 4000 TOWN CTR STE 700
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-1424
Country : US
Telephone Number : 248-386-0300
Fax Number :
Provider Business Practice Location Address
First Line : 6700 W OUTER DR
Second Line :
City : DETROIT
State : MI
Zip : 48235-2724
Country : US
Telephone Number : 313-836-1700
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. MOHAMMAD ASHRAF QAZI
Credential :
Telephone Number : 248-386-0300
Provider Enumeration Date : 07/05/2005
Last Update Date : 11/16/2016

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Directions to “OUTER DRIVE PARTNERS LLC ” Practice Location

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