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General NPI Number Information
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NPI Number | 1912933540
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Entity Type | Organization
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Legal Business Name | MMG 1 PC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 32255 NORTHWESTERN HWY STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1573
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Country | US
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Telephone | 248-945-0000
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Fax | 248-945-1819
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Provider Business Mailing Address
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Address Line | 29992 NORTHWESTERN HWY SUITE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3292
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Country | US
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Telephone | 248-851-1430
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Fax | 248-851-5182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEOFFREY A. TRIVAX
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Credential | M.D.
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Telephone | 248-851-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 207RM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Internal Medicine Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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Taxonomy #10
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #11
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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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