Provider Demographics
NPI:1194042176
Name:NOVI HEALTH CENTER P C
Entity Type:Organization
Organization Name:NOVI HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-477-4411
Mailing Address - Street 1:39575 W 10 MILE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2949
Mailing Address - Country:US
Mailing Address - Phone:248-477-4411
Mailing Address - Fax:248-477-4413
Practice Address - Street 1:39575 W 10 MILE RD STE 205
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2949
Practice Address - Country:US
Practice Address - Phone:248-477-4411
Practice Address - Fax:248-477-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1383550Medicaid
MIB44347Medicare UPIN
MI1383550Medicaid