Healthcare Provider Details

I. General information

NPI: 1609052885
Provider Name (Legal Business Name): MIDWEST HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
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

Practice location:
  • Phone: 313-581-2600
  • Fax: 313-581-0228
Mailing address:
  • Phone: 313-581-2600
  • Fax: 313-581-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MARK B SAFFER
Title or Position: CEO
Credential:
Phone: 313-581-2600