Healthcare Provider Details

I. General information

NPI: 1457644163
Provider Name (Legal Business Name): ASSOCIATED MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 W 12 MILE RD SUITE 1
SOUTHFIELD MI
48076-2115
US

IV. Provider business mailing address

2000 TOWN CTR SUITE 625
SOUTHFIELD MI
48075-1135
US

V. Phone/Fax

Practice location:
  • Phone: 248-443-1995
  • Fax: 248-443-5573
Mailing address:
  • Phone: 248-440-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DAVID KATZ
Title or Position: MANAGER
Credential: D.C.
Phone: 248-440-7100