Provider Demographics
NPI:1295865954
Name:ROSS SUMMERS MD PLLC
Entity Type:Organization
Organization Name:ROSS SUMMERS MD PLLC
Other - Org Name:MEDICAL CLINIC OF NORTHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-349-0627
Mailing Address - Street 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1646
Mailing Address - Country:US
Mailing Address - Phone:248-349-0627
Mailing Address - Fax:248-380-9365
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1646
Practice Address - Country:US
Practice Address - Phone:248-349-0627
Practice Address - Fax:248-380-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074604207Q00000X
MI4301057732207Q00000X
MI4301071154207Q00000X
MI4301082667207Q00000X
MI4301068380207R00000X
MI43010580392085R0202X
MI4301046792208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB2510OtherRAILROAD MEDICARE
MI0H24993OtherMI BLUE CROSS AND BLUE SH
MI0M94870Medicare PIN