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General NPI Number Information
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NPI Number | 1366808438
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Entity Type | Organization
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Legal Business Name | OPTIMAL CONSULTANTS GROUP, LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 22972 LAHSER RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4408
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Country | US
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Telephone | 248-225-2072
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Fax | 248-792-2128
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Provider Business Mailing Address
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Address Line | 6715 BIRMINGHAM CLUB DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-3116
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Country | US
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Telephone | 248-225-2072
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Fax | 248-792-2128
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATHA KANNAN
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Credential | M.D.
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Telephone | 248-225-2072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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