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General NPI Number Information
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NPI Number | 1003351214
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Entity Type | Organization
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Legal Business Name | SPASSOVA MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 18770 FARMINGTON RD SUITE 100
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City | LIVONIA
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State | MI
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Zip | 48152-3292
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Country | US
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Telephone | 734-284-6338
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Fax | 734-293-0985
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Provider Business Mailing Address
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Address Line | 18770 FARMINGTON RD SUITE 100
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City | LIVONIA
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State | MI
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Zip | 48152-3292
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Country | US
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Telephone | 734-284-6338
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Fax | 734-293-0985
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GANKA SPASSOVA
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Credential | M.D.
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Telephone | 734-284-6338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301086697
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License Number State | MI
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