Healthcare Provider Details

I. General information

NPI: 1215481981
Provider Name (Legal Business Name): METRO PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 CONNER ST STE 2075
DETROIT MI
48213-3492
US

IV. Provider business mailing address

5555 CONNER ST STE 2075
DETROIT MI
48213-3492
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4301098588
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301098588
License Number StateMI

VIII. Authorized Official

Name: MAURICE SWIFT
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-579-9010