MEDICARE: STRATEGIC ALLIANCE GROUP

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1346196714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATEGIC ALLIANCE GROUP

Provider Business Mailing Address
First Line	:	4212 LESLIE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3245
Country	:	US
Telephone Number	:	248-766-2746
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 LESLIE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3245
Country	:	US
Telephone Number	:	248-766-2746
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KAU GOFAN
Credential	:
Telephone Number	:	248-766-2746

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “STRATEGIC ALLIANCE GROUP ” Practice Location

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