Healthcare Provider Details

I. General information

NPI: 1669631438
Provider Name (Legal Business Name): EUGENIUS SBC ANG, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RUSSELL RD STE B
TECUMSEH MI
49286-2072
US

IV. Provider business mailing address

PO BOX 3705
ANN ARBOR MI
48106-3705
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-7481
  • Fax: 517-423-1921
Mailing address:
  • Phone: 517-423-7481
  • Fax: 517-423-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301032535
License Number StateMI

VIII. Authorized Official

Name: JULIE HOLDRIDGE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 517-265-0229