Healthcare Provider Details

I. General information

NPI: 1093145377
Provider Name (Legal Business Name): METRO WOMENS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 SAINT ANTOINE ST SUITE 304
DETROIT MI
48201-1461
US

IV. Provider business mailing address

7148 RELIABLE PKWY
CHICAGO IL
60686-0071
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-0499
  • Fax: 313-833-8801
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID C KMAK
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 313-745-0499