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General NPI Number Information
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NPI Number | 1508892951
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE GUIDANCE CENTER OF MONROE PLLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 14930 LAPLAISANCE RD SUITE 103
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City | MONROE
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State | MI
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Zip | 48161-3880
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Country | US
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Telephone | 734-241-4851
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Fax | 734-241-6552
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Provider Business Mailing Address
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Address Line | 14930 LAPLAISANCE RD SUITE 103
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City | MONROE
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State | MI
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Zip | 48161-3880
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Country | US
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Telephone | 734-241-4851
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Fax | 734-241-6552
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Authorized Official
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Title or Position | OWNER
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Name | MUBEEN MEMON
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Credential | M.D.
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Telephone | 734-241-4851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301073530
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License Number State | MI
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