Healthcare Provider Details

I. General information

NPI: 1497959183
Provider Name (Legal Business Name): BI-COUNTY PHYSICIANS PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 EAST 10 MILE ROAD
WARREN MI
48089-2048
US

IV. Provider business mailing address

PO BOX 673852
DETROIT MI
48267-3852
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7300
  • Fax:
Mailing address:
  • Phone: 586-412-4000
  • Fax: 586-412-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KIBBLE
Title or Position: DIRECTOR OF PHYSICIAN PRACTICE DEVE
Credential:
Phone: 586-759-7300