Healthcare Provider Details

I. General information

NPI: 1912295262
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 12/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0996
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY SUITE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-0123
  • Fax: 248-336-3190
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY H. MARGOLIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-851-1430