=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386873651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMC BILLING ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2009
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2455 UNION LAKE RD SUITE 101
-----------------------------------------------------
City | COMMERCE TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48382-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-360-6000
-----------------------------------------------------
Fax | 248-360-6040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 673671
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48267-3671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-360-6000
-----------------------------------------------------
Fax | 248-360-6040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VP
-----------------------------------------------------
Name | TIM RYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-966-2111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------