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General NPI Number Information
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NPI Number | 1780173971
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL DEVELOPMENT
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 29155 NORTHWESTERN HWY STE 428
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1011
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Country | US
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Telephone | 877-220-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 29155 NORTHWESTERN HWY STE 428
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ANZOUR S JALLOUQA
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Credential |
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Telephone | 877-220-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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