Healthcare Provider Details

I. General information

NPI: 1699720607
Provider Name (Legal Business Name): RIVER DISTRICT EMERGENCY PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 RIVER RD
EAST CHINA MI
48054-2909
US

IV. Provider business mailing address

17717 MASONIC
FRASER MI
48026-3158
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-7111
  • Fax:
Mailing address:
  • Phone: 586-294-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES M. FOX
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 248-642-9893