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General NPI Number Information
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NPI Number | 1518745017
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Entity Type | Organization
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Legal Business Name | PLEXUS GASTRO PLLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 6501 GREENFIELD RD
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City | DETROIT
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State | MI
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Zip | 48228-4780
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Country | US
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Telephone | 313-651-7053
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Fax | 313-435-0535
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Provider Business Mailing Address
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Address Line | 9025 PARDEE RD
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City | TAYLOR
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State | MI
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Zip | 48180-2755
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Country | US
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Telephone | 313-315-1422
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Fax | 313-435-0535
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | REGINA G HICKS
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Credential |
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Telephone | 586-489-9436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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