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General NPI Number Information
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NPI Number | 1174762686
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL GROUP SOUTH PC
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Dates
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Enumeration Date | 02/08/2009
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Last Update Date | 02/08/2009
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Provider Practice Location Address
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Address Line | 10501 TELEGRAPH RD
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City | TAYLOR
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State | MI
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Zip | 48180-3375
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Country | US
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Telephone | 313-295-7200
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Fax | 313-295-0009
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Provider Business Mailing Address
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Address Line | 25241 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1404
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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 | PRESIDENT
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Name | DR. ABRAHAM SLAIM
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Credential | D.O.
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Telephone | 313-295-3388
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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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