Healthcare Provider Details

I. General information

NPI: 1861799538
Provider Name (Legal Business Name): PEOPLES COMMUNITY MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 VISGER RD
RIVER ROUGE MI
48218-1037
US

IV. Provider business mailing address

310 VISGER RD
RIVER ROUGE MI
48218-1037
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-6077
  • Fax: 313-383-6096
Mailing address:
  • Phone: 313-383-6077
  • Fax: 313-383-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301040568
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERTO J WILLIAM
Title or Position: INTERNIST
Credential: M.D.
Phone: 313-510-4457