Healthcare Provider Details

I. General information

NPI: 1447352075
Provider Name (Legal Business Name): MILLENNIUM MEDICAL GROUP WEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 N WAYNE RD
WESTLAND MI
48185-7128
US

IV. Provider business mailing address

6149 N WAYNE RD
WESTLAND MI
48185-7128
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-2130
  • Fax: 734-728-2626
Mailing address:
  • Phone: 734-728-2130
  • Fax: 734-728-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM R SILVERSTONE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-728-2130