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General NPI Number Information
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NPI Number | 1104074582
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Entity Type | Organization
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Legal Business Name | FRIENDLY NEIGHBORHOOD MEDICAL CLINIC II
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 18606 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48223-2315
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Country | US
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Telephone | 313-273-2000
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Fax | 313-273-2020
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Provider Business Mailing Address
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Address Line | 18606 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48223-2315
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Country | US
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Telephone | 313-273-2000
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Fax | 313-273-2020
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. NANCY ROCHELLE WILLIAMS
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Credential |
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Telephone | 313-273-2000
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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