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General NPI Number Information
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NPI Number | 1801304688
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 248-912-8080
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Fax | 734-462-0340
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Provider Business Mailing Address
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Address Line | 17177 N LAUREL PARK DR STE 439
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City | LIVONIA
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State | MI
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Zip | 48152-3938
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Country | US
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Telephone | 734-462-0340
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Fax | 734-462-0344
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RIZWAN KHAN
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Credential | MD
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Telephone | 248-912-8080
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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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