Provider Demographics
NPI:1063503910
Name:MEDICAL SERVICES OF DETROIT
Entity Type:Organization
Organization Name:MEDICAL SERVICES OF DETROIT
Other - Org Name:GREENFIELD MEDICAL AND URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STARRLITE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEHN
Authorized Official - Suffix:
Authorized Official - Credentials:CMBS, CMA
Authorized Official - Phone:248-569-9523
Mailing Address - Street 1:24261 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3117
Mailing Address - Country:US
Mailing Address - Phone:248-569-9523
Mailing Address - Fax:248-569-9529
Practice Address - Street 1:24261 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3117
Practice Address - Country:US
Practice Address - Phone:248-569-9523
Practice Address - Fax:248-569-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036560305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization