Healthcare Provider Details

I. General information

NPI: 1629117072
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0926
US

IV. Provider business mailing address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0926
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-0123
  • Fax: 248-336-3190
Mailing address:
  • Phone: 248-336-0123
  • Fax: 248-336-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD MOYLAN
Title or Position: PARTNER
Credential: MD
Phone: 248-336-0123