Provider Demographics
NPI:1114270519
Name:ENDOCRINE AND METABOLIC DISORDERS CENTER PC
Entity Type:Organization
Organization Name:ENDOCRINE AND METABOLIC DISORDERS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-737-7520
Mailing Address - Street 1:2177 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3806
Mailing Address - Country:US
Mailing Address - Phone:586-737-7520
Mailing Address - Fax:586-737-7591
Practice Address - Street 1:2177 AUBURN RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-3806
Practice Address - Country:US
Practice Address - Phone:586-737-7520
Practice Address - Fax:586-737-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066588207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114270519Medicaid
MI110H703530OtherBCN GRP
MI110H703530OtherBCBS GRP
MI1114270519Medicaid