Healthcare Provider Details

I. General information

NPI: 1124651435
Provider Name (Legal Business Name): NAVIHEALTH MICHIGAN HBPC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TOWNE SQ STE 275
SOUTHFIELD MI
48076-3719
US

IV. Provider business mailing address

210 WESTWOOD PL STE 400
BRENTWOOD TN
37027-7554
US

V. Phone/Fax

Practice location:
  • Phone: 615-577-1933
  • Fax:
Mailing address:
  • Phone: 615-577-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE CEULE
Title or Position: SECRETARY
Credential: JURIS DOCTOR
Phone: 615-577-1933