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General NPI Number Information
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NPI Number | 1780864736
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Entity Type | Organization
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Legal Business Name | BICOUNTY MEDICAL PRACTICES
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 13355 E 10 MILE RD STE 110
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City | WARREN
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State | MI
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Zip | 48089-2048
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Country | US
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Telephone | 586-759-1080
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Fax | 586-759-1085
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Provider Business Mailing Address
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Address Line | 13355 E 10 MILE RD STE 110
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City | WARREN
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State | MI
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Zip | 48089-2048
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Country | US
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Telephone | 586-759-1080
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Fax | 586-759-1085
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | SUE COLOMINA
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Credential |
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Telephone | 586-759-7988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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