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General NPI Number Information
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NPI Number | 1588722649
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Entity Type | Organization
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Legal Business Name | S.P.O.R.T. PHYSICIANS, P.C.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 1950 E WATTLES RD SUITE 110
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City | TROY
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State | MI
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Zip | 48085-5099
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Country | US
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Telephone | 248-528-0050
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Fax | 248-528-0909
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Provider Business Mailing Address
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Address Line | 1950 E WATTLES RD SUITE 110
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City | TROY
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State | MI
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Zip | 48085-5099
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Country | US
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Telephone | 248-528-0050
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Fax | 248-528-0909
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JOYCE HOEY
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Credential |
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Telephone | 248-528-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301406072
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301046108
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License Number State | MI
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