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General NPI Number Information
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NPI Number | 1942524624
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Entity Type | Organization
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Legal Business Name | BI COUNTY MEDICAL PRACTICES
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 27500 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-4586
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Country | US
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Telephone | 586-755-1606
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Fax | 586-755-1857
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Provider Business Mailing Address
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Address Line | PO BOX 673195
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City | DETROIT
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State | MI
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Zip | 48267-3195
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Country | US
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Telephone | 810-720-5715
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Fax | 810-732-0891
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Authorized Official
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Title or Position | CFO
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Name | TERRY GOODBALIAN
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Credential |
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Telephone | 586-263-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | MI
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