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General NPI Number Information
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NPI Number | 1588078943
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Entity Type | Organization
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Legal Business Name | MAGNUM MANAGEMENT INC.
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 17600 W 8 MILE RD SUITE 7
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4305
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Country | US
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Telephone | 248-424-9749
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Fax |
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Provider Business Mailing Address
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Address Line | 17600 WEST EIGHT MILE RD SUITE 7
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4316
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Country | US
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Telephone | 248-424-9749
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY HERMAN REID
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Credential | D.O.
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Telephone | 248-424-9749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 5101007121
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License Number State | MI
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