Provider Demographics
NPI:1194002824
Name:SUPERIOR PHYSICIAN SERVICES PLLC
Entity Type:Organization
Organization Name:SUPERIOR PHYSICIAN SERVICES PLLC
Other - Org Name:GO DOCS GO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-881-4018
Mailing Address - Street 1:315 E EISENHOWER PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3329
Mailing Address - Country:US
Mailing Address - Phone:617-447-4403
Mailing Address - Fax:
Practice Address - Street 1:315 E EISENHOWER PKWY STE 7
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3329
Practice Address - Country:US
Practice Address - Phone:617-447-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty