Healthcare Provider Details

I. General information

NPI: 1881874923
Provider Name (Legal Business Name): STRENGTH & HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N OAKLAND BLVD
WATERFORD MI
48327-1547
US

IV. Provider business mailing address

1305 N OAKLAND BLVD
WATERFORD MI
48327-1547
US

V. Phone/Fax

Practice location:
  • Phone: 248-857-7583
  • Fax:
Mailing address:
  • Phone: 248-857-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301081689
License Number StateMI

VIII. Authorized Official

Name: PEGGY HAGEN
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 248-857-7583