Healthcare Provider Details
I. General information
NPI: 1659394997
Provider Name (Legal Business Name): MIDWEST HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/26/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5050 SCHAEFER RD
DEARBORN MI
48126-3249
US
IV. Provider business mailing address
5050 SCHAEFER RD
DEARBORN MI
48126-3249
US
V. Phone/Fax
- Phone: 313-581-2600
- Fax:
- Phone: 313-581-2600
- Fax: 313-581-0228
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207K00000X |
| Taxonomy | Allergy & Immunology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RR0500X |
| Taxonomy | Rheumatology Physician |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RI0011X |
| Taxonomy | Interventional Cardiology Physician |
| License Number | |
| License Number State | MI |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARK
B
SAFFER
Title or Position: CEO
Credential: DPM
Phone: 313-581-2600