=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700236478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSH-MI PHYSICIANS GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2016
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11260 E JEFFERSON AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48214-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-749-0148
-----------------------------------------------------
Fax | 313-263-3298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 746723
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-6723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-352-1515
-----------------------------------------------------
Fax | 312-929-0373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | DR. TERRANCE MORTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 740-607-4835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------