Healthcare Provider Details

I. General information

NPI: 1831433218
Provider Name (Legal Business Name): CONCERTO MEDICAL GROUP OF MICHIGAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2012
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 2ND AVE STE 210
DETROIT MI
48202-2739
US

IV. Provider business mailing address

7430 2ND AVE STE 210
DETROIT MI
48202-2739
US

V. Phone/Fax

Practice location:
  • Phone: 313-748-4200
  • Fax: 313-748-4186
Mailing address:
  • Phone: 313-748-4200
  • Fax: 313-748-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4704203621
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY RITA BECKER
Title or Position: SECRETARY
Credential: ESQ.
Phone: 949-398-8413