Healthcare Provider Details

I. General information

NPI: 1891753950
Provider Name (Legal Business Name): GREATER MICHIGAN CARDIOVASCULAR SURGEONS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 400
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 400
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2422
  • Fax: 313-441-2488
Mailing address:
  • Phone: 313-436-2422
  • Fax: 313-441-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE C WASHINGTON
Title or Position: MANAGING AGENT OWNER
Credential: MD
Phone: 313-436-2422