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General NPI Number Information
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NPI Number | 1154705374
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Entity Type | Organization
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Legal Business Name | MICHIGAN MEDICAL CLINICS, INC
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 29984 TELEGRAPH RD STE B
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1355
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Country | US
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Telephone | 248-933-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 KINGSTOWNE DR
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City | COMMERCE TWP
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State | MI
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Zip | 48390-2712
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Country | US
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Telephone | 248-933-1224
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF BOARD OF DIRECTORS
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Name | ALEX OLKHOVSKY
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Credential |
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Telephone | 248-933-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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