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General NPI Number Information
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NPI Number | 1023216165
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Entity Type | Organization
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Legal Business Name | BLESSED MC, LLC.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 34441 8 MILE RD STE 104
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City | LIVONIA
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State | MI
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Zip | 48152-4013
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Country | US
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Telephone | 313-772-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 34441 8 MILE RD STE 104
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City | LIVONIA
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State | MI
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Zip | 48152-4013
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Country | US
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Telephone | 313-772-0406
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JUAN ESTEBAN VILLA
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Credential |
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Telephone | 313-772-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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