Provider Demographics
NPI:1326362484
Name:THE GROSSE POINTE MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:THE GROSSE POINTE MEDICAL GROUP, PLLC
Other - Org Name:MERIDIAN FAMILY PHYSICIANS, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-469-8281
Mailing Address - Street 1:15120 KERCHEVAL AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230
Mailing Address - Country:US
Mailing Address - Phone:313-469-8281
Mailing Address - Fax:313-458-8864
Practice Address - Street 1:15120 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:313-469-8281
Practice Address - Fax:313-458-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF83258Medicare UPIN
MIM55400002Medicare PIN