Healthcare Provider Details

I. General information

NPI: 1528334992
Provider Name (Legal Business Name): TRUSTED COMMUNITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 W FORT ST SUITE 2
DETROIT MI
48209-2917
US

IV. Provider business mailing address

7140 W FORT ST SUITE 2
DETROIT MI
48209-2917
US

V. Phone/Fax

Practice location:
  • Phone: 313-685-1208
  • Fax: 313-388-0593
Mailing address:
  • Phone: 313-685-1208
  • Fax: 313-388-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CLARENCE JONES
Title or Position: PRESIDENT
Credential: PODIATRIST
Phone: 313-685-7170