MEDICARE: CG INC

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	3336C0003X	Community/Retail Pharmacy	5301009192	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2373253	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1831422294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CG INC

Provider Business Mailing Address
First Line	:	PO BOX 85990
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-6090
Country	:	US
Telephone Number	:	248-886-8175
Fax Number	:	248-886-8171

Provider Business Practice Location Address
First Line	:	2550 S TELEGRAPH RD STE 107A
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0951
Country	:	US
Telephone Number	:	248-886-8175
Fax Number	:	248-886-8171

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JYOTSNABEN PATEL
Credential	:
Telephone Number	:	248-886-8175

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	07/22/2011

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Directions to “CG INC ” Practice Location

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