Provider Demographics
NPI:1093276602
Name:MOBILE PHYSICIANS NETWORK OF MICHIGAN PC
Entity Type:Organization
Organization Name:MOBILE PHYSICIANS NETWORK OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEININGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-318-5213
Mailing Address - Street 1:5151 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2184
Mailing Address - Country:US
Mailing Address - Phone:419-318-5213
Mailing Address - Fax:419-882-5008
Practice Address - Street 1:1874 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1808
Practice Address - Country:US
Practice Address - Phone:419-882-5000
Practice Address - Fax:419-882-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty