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NPI Code Detail

MEDICARE: DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC

MEDICARE: DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC
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
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1366028730
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 305-628-6117
Fax Number :
Provider Business Practice Location Address
First Line : 13210 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48215-2704
Country : US
Telephone Number : 313-335-3444
Fax Number :
Authorized Official
Title or Position : EXECUTIVE OFFICER
Name : MARY CHEN
Credential :
Telephone Number : 305-628-6117
Provider Enumeration Date : 03/24/2021
Last Update Date : 03/24/2021

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Directions to “DEDICATED PHYSICIANS GROUP OF MICHIGAN PLLC ” Practice Location

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