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General NPI Number Information
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NPI Number | 1821002734
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Entity Type | Organization
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Legal Business Name | MICHIGAN SERVICES NETWORK INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 OAKLAND AVE SUITE C
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City | PONTIAC
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State | MI
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Zip | 48342-2019
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Country | US
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Telephone | 313-459-5499
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Fax | 501-636-5236
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Provider Business Mailing Address
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Address Line | 31 OAKLAND AVE SUITE C
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City | PONTIAC
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State | MI
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Zip | 48342-2019
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Country | US
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Telephone | 313-459-5499
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Fax | 501-636-5236
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Authorized Official
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Title or Position | DIRECTOR
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Name | FIDEL RODRIGUEZ
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Credential |
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Telephone | 313-459-5499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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