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General NPI Number Information
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NPI Number | 1578072906
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Entity Type | Organization
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Legal Business Name | BEAUMONT MEDICAL GROUP- SPECIALTY SERVICES
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 3601 W 13 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-6712
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Country | US
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Telephone | 248-898-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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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 | SR. VP BEAUMONT PHYSICIAN PARTNERS
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Name | JONATHAN SCOTT MANER
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Credential |
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Telephone | 947-522-1912
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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 |
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License Number State |
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