Healthcare Provider Details

I. General information

NPI: 1659695336
Provider Name (Legal Business Name): BI COUNTY MEDICAL PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 06/17/2010
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 673195
DETROIT MI
48267-3195
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7510
  • Fax: 586-759-7791
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: TERRY GOODBALIAN
Title or Position: CFO
Credential:
Phone: 586-263-2705