Provider Demographics
NPI:1174286017
Name:GREAT PHYSICIANS, PC
Entity Type:Organization
Organization Name:GREAT PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-820-1712
Mailing Address - Street 1:909 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1755
Mailing Address - Country:US
Mailing Address - Phone:248-820-1712
Mailing Address - Fax:248-469-0966
Practice Address - Street 1:5032 ROCHESTER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3454
Practice Address - Country:US
Practice Address - Phone:248-250-9029
Practice Address - Fax:248-250-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty