Healthcare Provider Details

I. General information

NPI: 1790874006
Provider Name (Legal Business Name): VIRGINIA PARK MEDICAL CENTER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 14TH ST
DETROIT MI
48206-2425
US

IV. Provider business mailing address

8500 14TH ST
DETROIT MI
48206-2425
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-3950
  • Fax: 313-894-1729
Mailing address:
  • Phone: 313-894-3950
  • Fax: 313-894-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOH27778
License Number StateMI

VIII. Authorized Official

Name: DR. CLAUD R. YOUNG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 313-897-3950