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General NPI Number Information
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NPI Number | 1841081908
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Entity Type | Organization
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Legal Business Name | OMEGA SPECIALTY GROUP PLC
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 18570 GRAND RIVER AVE STE 102
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City | DETROIT
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State | MI
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Zip | 48223-2201
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Country | US
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Telephone | 313-646-4681
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Fax | 313-646-4687
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Provider Business Mailing Address
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Address Line | 18570 GRAND RIVER AVE STE 102
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City | DETROIT
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State | MI
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Zip | 48223-2201
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Country | US
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Telephone | 313-646-4681
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Fax | 313-646-4687
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CARTER
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Credential |
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Telephone | 313-646-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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