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General NPI Number Information
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NPI Number | 1740447481
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Entity Type | Organization
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Legal Business Name | MEDICAL DOCTORS OF MICHIGAN, PLLC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 5460 DOHERTY ST
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3419
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Country | US
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Telephone | 248-240-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 5460 DOHERTY ST
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3419
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Country | US
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Telephone | 248-240-0077
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. VIVINA COVACHA ROSAL
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Credential | MD
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Telephone | 248-240-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301034721
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License Number State | MI
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