Healthcare Provider Details

I. General information

NPI: 1003277187
Provider Name (Legal Business Name): SILVERTON MEDICAL PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21333 HAGGERTY RD SUITE 150
NOVI MI
48375-5510
US

IV. Provider business mailing address

21333 HAGGERTY RD SUITE 150
NOVI MI
48375-5510
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-0250
  • Fax: 248-662-9845
Mailing address:
  • Phone: 248-662-0250
  • Fax: 248-662-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: THOMAS M. PROSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-662-0250