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General NPI Number Information
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NPI Number | 1518272236
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Entity Type | Organization
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Legal Business Name | MICHIGAN CENTER FOR BREAST HEALTH
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 2486 NERREDIA ST SUITE A
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City | FLINT
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State | MI
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Zip | 48532-4807
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Country | US
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Telephone | 810-720-9900
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Fax | 810-720-0011
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Provider Business Mailing Address
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Address Line | 2486 NERREDIA ST SUITE A
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City | FLINT
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State | MI
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Zip | 48532-4807
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Country | US
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Telephone | 810-720-9900
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Fax | 810-720-0011
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Authorized Official
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Title or Position | SOLE MBR/CEO
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Name | LINSEY GOLD
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Credential | D.O.
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Telephone | 810-720-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1651783
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License Number State | MI
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