MEDICARE: DETROIT MEDICAL CLINIC 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
1	261Q00000X	Clinic/Center	4301071164	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245244110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT MEDICAL CLINIC PC

Provider Business Mailing Address
First Line	:	4059 W . DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238
Country	:	US
Telephone Number	:	313-491-5400
Fax Number	:	313-491-8123

Provider Business Practice Location Address
First Line	:	4059 W DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3262
Country	:	US
Telephone Number	:	313-491-5400
Fax Number	:	313-491-8123

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEX-ABBEY AKINWUMI
Credential	:	MD
Telephone Number	:	313-491-5400

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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