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General NPI Number Information
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NPI Number | 1699004226
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Entity Type | Organization
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Legal Business Name | ADVANCED OB-GYN OF MICHIGAN
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 02/26/2012
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Provider Practice Location Address
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Address Line | 18400 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3588
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Country | US
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Telephone | 248-471-9570
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Fax | 248-471-9603
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Provider Business Mailing Address
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Address Line | 26680 ROSE HILL DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-4572
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Country | US
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Telephone | 248-345-5201
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DESPINA WALSWORTH
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Credential | M.D.
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Telephone | 248-345-5201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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