MEDICARE: DAVID O WASHINGTON MDPC

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	261QP2300X	Primary Care Clinic/Center	4301062062	MI

General Provider Information

NPI Number	:	1558538132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID O WASHINGTON MDPC

Provider Business Mailing Address
First Line	:	19251 BRETTON DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1363
Country	:	US
Telephone Number	:	313-452-0384
Fax Number	:

Provider Business Practice Location Address
First Line	:	19251 BRETTON DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1363
Country	:	US
Telephone Number	:	313-452-0384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID O WASHINGTON
Credential	:	MD
Telephone Number	:	313-452-0384

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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