Healthcare Provider Details

I. General information

NPI: 1528756434
Provider Name (Legal Business Name): MCM HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 PEMBROKE AVE
DETROIT MI
48235-2352
US

IV. Provider business mailing address

24555 SOUTHFIELD RD STE 100
SOUTHFIELD MI
48075-2788
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNANE ROBINSON
Title or Position: CEO
Credential:
Phone: 313-790-5299