Healthcare Provider Details

I. General information

NPI: 1821813189
Provider Name (Legal Business Name): PRM GYNECOLOGY OF MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 AXTELL DR STE 105
TROY MI
48084-4400
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 700
WEST PALM BEACH FL
33409-6508
US

V. Phone/Fax

Practice location:
  • Phone: 248-282-2202
  • Fax:
Mailing address:
  • Phone: 561-422-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE LAGNESE
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 561-422-4206