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NPI Code Detail

MEDICARE: JUDITH M. EDGE DO

MEDICARE: JUDITH M. EDGE DO
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
1207R00000XInternal Medicine Physician5101009282MI

General Provider Information

NPI Number : 1790771475
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH M. EDGE DO
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number : 947-522-1862
Fax Number : 947-522-0307
Provider Business Practice Location Address
First Line : 27015 W WARREN ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-1901
Country : US
Telephone Number : 313-278-1982
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 11/21/2023

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