Healthcare Provider Details

I. General information

NPI: 1295768968
Provider Name (Legal Business Name): MEDIC-ONE VISITING PHYSICIAN SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33424 DEQUINDRE RD SUITE A
STERLING HEIGHTS MI
48310-5878
US

IV. Provider business mailing address

33424 DEQUINDRE RD SUITE A
STERLING HEIGHTS MI
48310-5878
US

V. Phone/Fax

Practice location:
  • Phone: 586-983-5687
  • Fax: 586-983-5517
Mailing address:
  • Phone: 586-983-5687
  • Fax: 586-983-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number5101007369
License Number StateMI

VIII. Authorized Official

Name: DR. ARTHUR BOUIER
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 586-983-5687