Healthcare Provider Details

I. General information

NPI: 1699088468
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 N SILVERY LN SUITE 202
DEARBORN HEIGHTS MI
48127-4515
US

IV. Provider business mailing address

8560 N SILVERY LN SUITE202
DEARBORN HEIGHTS MI
48127-4515
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-3255
  • Fax: 313-581-3755
Mailing address:
  • Phone: 313-581-3255
  • Fax: 313-581-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number5101008800
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number510010514
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301031988
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016943
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number510014180
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101013938
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301096741
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301083370
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number5101015292
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4304373315
License Number StateMI
# 11
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number430175238
License Number StateMI
# 12
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number5101008581
License Number StateMI
# 13
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101011584
License Number StateMI
# 14
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101017430
License Number StateMI
# 15
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301040917
License Number StateMI

VIII. Authorized Official

Name: ALLIE GALOVICH
Title or Position: BILLER
Credential: CPC
Phone: 248-390-0459