Healthcare Provider Details

I. General information

NPI: 1417124272
Provider Name (Legal Business Name): TRAVELING MEDICAL SERVICES II, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 W 9 MILE RD STE 340
SOUTHFIELD MI
48075-4426
US

IV. Provider business mailing address

17515 W 9 MILE RD STE 340
SOUTHFIELD MI
48075-4426
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-2695
  • Fax: 248-569-7250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURIE ANDREWS
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-569-2695