Healthcare Provider Details

I. General information

NPI: 1083647077
Provider Name (Legal Business Name): GRACE NEONATOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

PO BOX 321061
DETROIT MI
48232-1061
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-8070
  • Fax:
Mailing address:
  • Phone: 248-543-8070
  • Fax: 248-543-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEH-CHYANG LIANG
Title or Position: MANAGER
Credential: MD
Phone: 248-543-8070