Healthcare Provider Details

I. General information

NPI: 1811224751
Provider Name (Legal Business Name): PHYSICIANS PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30808 ISLAND DR
GIBRALTAR MI
48173-9547
US

IV. Provider business mailing address

30808 ISLAND DR
GIBRALTAR MI
48173-9547
US

V. Phone/Fax

Practice location:
  • Phone: 734-915-1270
  • Fax: 734-250-7377
Mailing address:
  • Phone: 734-915-1270
  • Fax: 734-250-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIM CHARLES DESANO
Title or Position: ADMINISTRATOR
Credential:
Phone: 734-915-1270