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General NPI Number Information
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NPI Number | 1023105418
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Entity Type | Organization
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Legal Business Name | OWOSSO MEDICAL GROUP, PC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 200 HEALTH PARK DRIVE
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City | OWOSSO
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State | MI
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Zip | 48867
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Country | US
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Telephone | 989-723-8666
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Fax | 989-729-4983
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Provider Business Mailing Address
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Address Line | 200 HEALTH PARK DRIVE
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City | OWOSSO
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State | MI
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Zip | 48867
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Country | US
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Telephone | 989-723-8666
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Fax | 989-729-4983
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. AZMY A ALLAM
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Credential | MD
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Telephone | 989-723-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | MI
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