Healthcare Provider Details

I. General information

NPI: 1487709630
Provider Name (Legal Business Name): ALBERT SPICKERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26193 MEREDITH DRIVE
WARREN MI
48091
US

IV. Provider business mailing address

26193 MEREDITH DRIVE
WARREN MI
48091
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-0395
  • Fax: 313-841-0580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301064378
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: