Healthcare Provider Details

I. General information

NPI: 1497165260
Provider Name (Legal Business Name): MIDWEST MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13927 PLUMBROOK RD
STERLING HEIGHTS MI
48312-1727
US

IV. Provider business mailing address

13927 PLUMBROOK RD
STERLING HEIGHTS MI
48312-1727
US

V. Phone/Fax

Practice location:
  • Phone: 586-978-8088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LOWELL FRIEDMAN
Title or Position: AUTHORIZED OFFICAL
Credential:
Phone: 248-932-0900