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NPI Code Detail

MEDICARE: ADVANCED GYNECOLOGY SPECIALISTS OF MI PC

MEDICARE: ADVANCED GYNECOLOGY SPECIALISTS OF MI PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianOK0348MI

General Provider Information

NPI Number : 1205949450
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED GYNECOLOGY SPECIALISTS OF MI PC
Provider Business Mailing Address
First Line : 44038 WOODWARD AVENUE
Second Line : SUITE 201
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-5037
Country : US
Telephone Number : 248-338-6611
Fax Number : 248-338-4742
Provider Business Practice Location Address
First Line : 44038 WOODWARD AVENUE
Second Line : SUITE 201
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-5037
Country : US
Telephone Number : 248-338-6611
Fax Number : 248-338-4742
Authorized Official
Title or Position : PHYSICIAN
Name : DR. OTHMAN KADRY
Credential : MD
Telephone Number : 248-338-6611
Provider Enumeration Date : 08/15/2006
Last Update Date : 08/22/2020

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