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General NPI Number Information
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NPI Number | 1245244110
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Entity Type | Organization
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Legal Business Name | DETROIT MEDICAL CLINIC PC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4059 W DAVISON
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City | DETROIT
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State | MI
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Zip | 48238-3262
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Country | US
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Telephone | 313-491-5400
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Fax | 313-491-8123
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Provider Business Mailing Address
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Address Line | 4059 W . DAVISON
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City | DETROIT
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State | MI
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Zip | 48238
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Country | US
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Telephone | 313-491-5400
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Fax | 313-491-8123
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX-ABBEY AKINWUMI
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Credential | MD
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Telephone | 313-491-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4301071164
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License Number State | MI
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