Provider Demographics
NPI:1114901782
Name:ASSOCIATES IN OBSTETRICS AND GYNECOLOGY PC
Entity Type:Organization
Organization Name:ASSOCIATES IN OBSTETRICS AND GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-465-4340
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-4340
Mailing Address - Fax:248-465-4341
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-465-4340
Practice Address - Fax:248-465-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160F301520OtherBLUE CROSS
MI4495560Medicaid
MI0N70340Medicare PIN