Healthcare Provider Details

I. General information

NPI: 1851798235
Provider Name (Legal Business Name): EXPRESS PHYSICIANS LIMITED LIABILITY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17330 NORTHLAND PARK CT
SOUTHFIELD MI
48075-4318
US

IV. Provider business mailing address

17330 NORTHLAND PARK CT
SOUTHFIELD MI
48075-4318
US

V. Phone/Fax

Practice location:
  • Phone: 313-399-7258
  • Fax: 248-552-8144
Mailing address:
  • Phone: 313-399-7258
  • Fax: 248-552-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HOWARD BALDWIN JR.
Title or Position: OWNER
Credential:
Phone: 313-399-7258