Healthcare Provider Details

I. General information

NPI: 1326457524
Provider Name (Legal Business Name): MAPLE MILLINNIUM MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30800 TELEGRAPH RD SUITE 2950
BINGHAM FARMS MI
48025-4542
US

IV. Provider business mailing address

30800 TELEGRAPH RD SUITE 2950
BINGHAM FARMS MI
48025-4542
US

V. Phone/Fax

Practice location:
  • Phone: 248-593-9780
  • Fax:
Mailing address:
  • Phone: 248-593-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC PAGE
Title or Position: COO
Credential:
Phone: 248-593-9780