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General NPI Number Information
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NPI Number | 1144787326
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Entity Type | Organization
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Legal Business Name | AT HOME PHYSICIAN MANAGEMENT GROUP CO.
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 27440 HOOVER RD STE C
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City | WARREN
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State | MI
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Zip | 48093-7726
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Country | US
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Telephone | 586-530-6017
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Fax |
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Provider Business Mailing Address
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Address Line | 27440 HOOVER RD STE C
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City | WARREN
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State | MI
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Zip | 48093-7726
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Country | US
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Telephone | 586-530-6017
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARIA C BROOKS
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Credential |
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Telephone | 586-530-6017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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