Healthcare Provider Details

I. General information

NPI: 1508143470
Provider Name (Legal Business Name): PREFERRED HOSPITALISTS OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

27450 SCHOENHERR RD 500
WARREN MI
48088-6683
US

V. Phone/Fax

Practice location:
  • Phone: 586-630-3624
  • Fax:
Mailing address:
  • Phone: 586-582-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERIE RIVARD
Title or Position: CLINIC OFFICE COORDINATOR
Credential:
Phone: 586-582-7632