Healthcare Provider Details

I. General information

NPI: 1982194338
Provider Name (Legal Business Name): GREEN CROSS MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18041 GREENFIELD RD
DETROIT MI
48235-3120
US

IV. Provider business mailing address

18041 GREENFIELD RD
DETROIT MI
48235-3120
US

V. Phone/Fax

Practice location:
  • Phone: 313-837-0072
  • Fax: 313-837-0003
Mailing address:
  • Phone: 313-837-0072
  • Fax: 313-837-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301033614
License Number StateMI

VIII. Authorized Official

Name: EMILIA SANTOS QUIZON
Title or Position: RN
Credential:
Phone: 248-563-8471