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General NPI Number Information
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NPI Number | 1558538132
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Entity Type | Organization
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Legal Business Name | DAVID O WASHINGTON MDPC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 19251 BRETTON DR
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City | DETROIT
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State | MI
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Zip | 48223-1363
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Country | US
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Telephone | 313-452-0384
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Fax |
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Provider Business Mailing Address
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Address Line | 19251 BRETTON DR
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City | DETROIT
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State | MI
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Zip | 48223-1363
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Country | US
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Telephone | 313-452-0384
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID O WASHINGTON
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Credential | MD
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Telephone | 313-452-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301062062
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License Number State | MI
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