Healthcare Provider Details

I. General information

NPI: 1386725091
Provider Name (Legal Business Name): MICHIGAN PERINATAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 MONROE ST STE 100
DEARBORN MI
48124-3057
US

IV. Provider business mailing address

2142 MONROE ST STE 100
DEARBORN MI
48124-3057
US

V. Phone/Fax

Practice location:
  • Phone: 313-481-1030
  • Fax: 313-481-1031
Mailing address:
  • Phone: 313-481-1030
  • Fax: 313-481-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOSES
Title or Position: DIRECTOR,OWNER
Credential:
Phone: 313-481-1030