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General NPI Number Information
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NPI Number | 1083801500
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Entity Type | Organization
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Legal Business Name | COMPLETEHEALTH MC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 32858 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3048
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Country | US
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Telephone | 734-716-4506
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Fax |
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Provider Business Mailing Address
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Address Line | 32858 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3048
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Country | US
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Telephone | 734-716-4506
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. MARIA J. HABER
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Credential |
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Telephone | 17347164506
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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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