Healthcare Provider Details

I. General information

NPI: 1073708772
Provider Name (Legal Business Name): BI-COUNTY CLINICAL PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD SUITE 229
WARREN MI
48089-2048
US

IV. Provider business mailing address

PO BOX 673937
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-6263
  • Fax: 586-758-7725
Mailing address:
  • Phone: 586-758-6263
  • Fax: 586-758-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KIBBLE
Title or Position: DIRECTOR
Credential:
Phone: 313-874-3436