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General NPI Number Information
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NPI Number | 1649721796
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Entity Type | Organization
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Legal Business Name | MI HOUSE PHYSICIAN PC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 17515 W 9 MILE RD SUITE 730
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4403
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Country | US
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Telephone | 248-233-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 17515 W 9 MILE RD SUITE 730
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4403
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Country | US
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Telephone | 248-233-6463
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | FLORENCE E THOMAS
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Credential | MD
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Telephone | 248-233-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301074204
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License Number State | MI
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