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General NPI Number Information
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NPI Number | 1093107682
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Entity Type | Organization
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Legal Business Name | MICHIGAN HEALTHCARE PROFESSIONALS
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 29245 RYAN RD SUITE 400
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City | WARREN
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State | MI
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Zip | 48092-4284
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Country | US
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Telephone | 586-576-0106
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Fax | 586-576-0235
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Provider Business Mailing Address
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Address Line | 29992 NORTHWESTERN HWY SUITE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3292
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Country | US
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Telephone | 248-851-1430
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Fax | 248-851-5182
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Authorized Official
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Title or Position | ASS SECRETARY OF CREDENTIALING
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Name | MS. MICHAELENE GOGOLIN
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Credential |
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Telephone | 248-851-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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