Healthcare Provider Details

I. General information

NPI: 1578534939
Provider Name (Legal Business Name): ALVIN L MCCORMICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DRIVE MC 69504
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

5301 E HURON RIVER DR MC 69504
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 734-827-8883
  • Fax: 734-827-8915
Mailing address:
  • Phone: 734-827-8883
  • Fax: 734-827-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301054525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: