Provider Demographics
NPI:1346690757
Name:DETROIT 74TH MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:DETROIT 74TH MEDICAL CLINIC INC
Other - Org Name:BETTY G TURCIOS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TURCIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-631-5749
Mailing Address - Street 1:4805 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3351
Mailing Address - Country:US
Mailing Address - Phone:216-631-5749
Mailing Address - Fax:216-631-5870
Practice Address - Street 1:4805 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3351
Practice Address - Country:US
Practice Address - Phone:216-631-5749
Practice Address - Fax:216-631-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty