Healthcare Provider Details

I. General information

NPI: 1689239683
Provider Name (Legal Business Name): MOTOR CITY MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BROADWAY SUITE 400
DETROIT MI
48226
US

IV. Provider business mailing address

1300 BROADWAY SUITE 400
DETROIT MI
48226
US

V. Phone/Fax

Practice location:
  • Phone: 313-680-3799
  • Fax:
Mailing address:
  • Phone: 586-335-2006
  • Fax: 586-279-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LAGROU
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 248-703-1869