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General NPI Number Information
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NPI Number | 1225185945
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Entity Type | Organization
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Legal Business Name | DOUGLAS M PORTZ MD PC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 14650 OLD HIGHWAY US12 SUITE 101
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City | CHELSEA
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State | MI
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Zip | 48118
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Country | US
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Telephone | 734-475-3979
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Fax | 734-433-4513
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Provider Business Mailing Address
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Address Line | 14650 OLD HIGHWAY US12 SUITE 101
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City | CHELSEA
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State | MI
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Zip | 48118
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Country | US
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Telephone | 734-475-3979
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Fax | 734-433-4513
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS M PORTZ
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Credential | MD
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Telephone | 734-475-3979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | DP049712
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License Number State | MI
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