Healthcare Provider Details

I. General information

NPI: 1619964517
Provider Name (Legal Business Name): MN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28111 NORTHLINE RD
ROMULUS MI
48174-2829
US

IV. Provider business mailing address

PO BOX 7
TAYLOR MI
48180-0007
US

V. Phone/Fax

Practice location:
  • Phone: 734-946-4008
  • Fax: 734-946-4872
Mailing address:
  • Phone: 734-946-4008
  • Fax: 734-946-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number382806532
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL GLENN TALLEY
Title or Position: PRESIDENT OWNER
Credential:
Phone: 734-946-4008