Healthcare Provider Details

I. General information

NPI: 1043535990
Provider Name (Legal Business Name): BI COUNTY CLINICAL PRACTICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27500 HOOVER RD SUITE 100
WARREN MI
48093-4586
US

IV. Provider business mailing address

PO BOX 673195
DETROIT MI
48267-3195
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-2558
  • Fax: 586-754-2426
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateMI

VIII. Authorized Official

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