Healthcare Provider Details

I. General information

NPI: 1669634358
Provider Name (Legal Business Name): VISITING PHYSICIAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 GREENFIELD RD 240
OAK PARK MI
48237-2581
US

IV. Provider business mailing address

21700 GREENFIELD RD 240
OAK PARK MI
48237-2581
US

V. Phone/Fax

Practice location:
  • Phone: 248-968-2500
  • Fax: 248-968-2501
Mailing address:
  • Phone: 248-968-2500
  • Fax: 248-968-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4301076297
License Number StateMI

VIII. Authorized Official

Name: DR. SUNANDA NIOGUY
Title or Position: PRESIDENT/OWNER
Credential: M.D
Phone: 248-289-6651