Healthcare Provider Details

I. General information

NPI: 1174762686
Provider Name (Legal Business Name): MILLENNIUM MEDICAL GROUP SOUTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2009
Last Update Date: 02/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 TELEGRAPH RD
TAYLOR MI
48180-3375
US

IV. Provider business mailing address

25241 GRAND RIVER AVE
REDFORD MI
48240-1404
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-7200
  • Fax: 313-295-0009
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABRAHAM SLAIM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 313-295-3388