Healthcare Provider Details

I. General information

NPI: 1225301070
Provider Name (Legal Business Name): BEDSIDE MEDICAL MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 E 12 MILE RD
WARREN MI
48088-3671
US

IV. Provider business mailing address

13450 E 12 MILE RD
WARREN MI
48088-3671
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-5525
  • Fax: 586-759-4765
Mailing address:
  • Phone: 586-759-5525
  • Fax: 586-759-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN K GREKIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 586-759-5525