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General NPI Number Information
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NPI Number | 1033934500
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Entity Type | Organization
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Legal Business Name | MICHIGAN STATE MEDICAL GROUP
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 53 W MAPLE RD
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City | CLAWSON
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State | MI
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Zip | 48017-1109
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Country | US
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Telephone | 586-256-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W MAPLE RD
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City | CLAWSON
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State | MI
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Zip | 48017-1109
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Country | US
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Telephone | 586-256-3725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABID H AGHA
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Credential | M.D.
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Telephone | 510-335-9918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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