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General NPI Number Information
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NPI Number | 1811653801
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Entity Type | Organization
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Legal Business Name | KANSAS TELEMEDICINE ASSOCIATES PC
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Dates
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Enumeration Date | 11/13/2021
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Last Update Date | 11/13/2021
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Provider Practice Location Address
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Address Line | 2957 BLOOMFIELD PARK DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3508
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Country | US
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Telephone | 248-543-4180
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Fax |
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Provider Business Mailing Address
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Address Line | 355 LEXINGTON AVE FL 12
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City | NEW YORK
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State | NY
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Zip | 10017-6612
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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 | CEO
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Name | ROBERT IGWE
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Credential | MD
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Telephone | 248-543-4180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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