MEDICARE: PAUL T PORTER M.D.

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
1	207RX0202X	Medical Oncology Physician	PP049599	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0829220	OTHER	MI	BCN

General Provider Information

NPI Number	:	1588678155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL T PORTER M.D.

Provider Business Mailing Address
First Line	:	19229 MACK AVE STE 24
Second Line	:
City	:	GROSSE POINTE WOODS
State	:	MI
Zip	:	48236-2857
Country	:	US
Telephone Number	:	313-884-5522
Fax Number	:	313-884-5521

Provider Business Practice Location Address
First Line	:	19229 MACK AVE STE 24
Second Line	:
City	:	GROSSE POINTE WOODS
State	:	MI
Zip	:	48236-2857
Country	:	US
Telephone Number	:	313-884-5522
Fax Number	:	313-884-5521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/29/2008

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Directions to “ PAUL T PORTER M.D.” Practice Location

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