Provider Demographics
NPI:1083845291
Name:MOBILE DOCTORS PLLC
Entity Type:Organization
Organization Name:MOBILE DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:POONPANIJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-840-7470
Mailing Address - Street 1:27620 FARMINGTON RD STE 109
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3367
Mailing Address - Country:US
Mailing Address - Phone:248-840-7480
Mailing Address - Fax:800-660-6187
Practice Address - Street 1:27620 FARMINGTON RD STE 109
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3367
Practice Address - Country:US
Practice Address - Phone:248-840-7480
Practice Address - Fax:800-660-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032562208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty