Healthcare Provider Details

I. General information

NPI: 1366792087
Provider Name (Legal Business Name): PHOENIX MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 GREENFIELD RD STE 101B
OAK PARK MI
48237-2535
US

IV. Provider business mailing address

22150 GREENFIELD RD STE 101B
OAK PARK MI
48237-2535
US

V. Phone/Fax

Practice location:
  • Phone: 248-591-4158
  • Fax: 248-591-4168
Mailing address:
  • Phone: 248-591-4158
  • Fax: 248-591-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANK MIDDLETON
Title or Position: DIRECTOR
Credential:
Phone: 248-591-4158