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General NPI Number Information
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NPI Number | 1811945199
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Entity Type | Organization
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Legal Business Name | GENERAL MEDICINE, P.C.
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 21333 HAGGERTY RD SUITE 150
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City | NOVI
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State | MI
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Zip | 48375-5510
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Country | US
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Telephone | 248-662-0250
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Fax | 248-662-9844
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Provider Business Mailing Address
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Address Line | 21333 HAGGERTY RD SUITE 150
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City | NOVI
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State | MI
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Zip | 48375-5510
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Country | US
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Telephone | 248-662-0250
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Fax | 248-662-9844
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS MARK PROSE
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Credential | M.D.
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Telephone | 248-662-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State | MI
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