MEDICARE: SUMMIT VISITING PHYSICIANS GROUP, 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	207R00000X	Internal Medicine Physician	5101009248	MI

General Provider Information

NPI Number	:	1942696984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT VISITING PHYSICIANS GROUP, PC

Provider Business Mailing Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE 402
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-562-0883
Fax Number	:	313-562-0885

Provider Business Practice Location Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE 402
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-562-0883
Fax Number	:	313-562-0885

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMIAH A WEEKES
Credential	:	D.O.
Telephone Number	:	313-562-0883

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	02/29/2016

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