Healthcare Provider Details

I. General information

NPI: 1841081908
Provider Name (Legal Business Name): OMEGA SPECIALTY GROUP PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18570 GRAND RIVER AVE STE 102
DETROIT MI
48223-2201
US

IV. Provider business mailing address

18570 GRAND RIVER AVE STE 102
DETROIT MI
48223-2201
US

V. Phone/Fax

Practice location:
  • Phone: 313-646-4681
  • Fax: 313-646-4687
Mailing address:
  • Phone: 313-646-4681
  • Fax: 313-646-4687

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 Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CARTER
Title or Position: OWNER
Credential:
Phone: 313-646-5180