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General NPI Number Information
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NPI Number | 1679806996
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Entity Type | Organization
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Legal Business Name | BIRMINGHAM ROYAL OAK MEDICAL GROUP PC
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 5130 COOLIDGE HWY
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City | ROYAL OAK
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State | MI
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Zip | 48073-1001
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Country | US
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Telephone | 248-288-9500
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Fax | 248-288-0044
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Provider Business Mailing Address
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Address Line | 5130 COOLIDGE HWY
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City | ROYAL OAK
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State | MI
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Zip | 48073-1001
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Country | US
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Telephone | 248-288-9500
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Fax | 248-288-0044
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Authorized Official
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Title or Position | OWNER MEDICAL DIRECTOR PHYSICIAN
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Name | DR. MUMTAZ GEORGE
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Credential | MD
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Telephone | 248-288-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 4301038490
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License Number State | MI
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