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General NPI Number Information
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NPI Number | 1467881573
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Entity Type | Organization
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Legal Business Name | ACCESS
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 6451 SCHAEFER RD
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City | DEARBORN
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State | MI
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Zip | 48126-2212
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Country | US
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Telephone | 313-584-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 6451 SCHAEFER RD
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City | DEARBORN
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State | MI
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Zip | 48126-2212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MONA MAKKI
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Credential |
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Telephone | 313-584-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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