Healthcare Provider Details

I. General information

NPI: 1952529091
Provider Name (Legal Business Name): ALEX PICKENS & ASSOC M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15639 W MCNICHOLS RD
DETROIT MI
48235-3541
US

IV. Provider business mailing address

PO BOX 23518
DETROIT MI
48223-0518
US

V. Phone/Fax

Practice location:
  • Phone: 313-272-2400
  • Fax: 313-535-9060
Mailing address:
  • Phone: 313-272-2400
  • Fax: 313-535-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number4301038348
License Number StateMI

VIII. Authorized Official

Name: DR. ALEX PICKENS JR.
Title or Position: MEDICAL DIRECTOR
Credential: M,D,
Phone: 313-272-2400