Provider Demographics
NPI:1356508907
Name:AGAPE WOMENS HEALTH PLC
Entity Type:Organization
Organization Name:AGAPE WOMENS HEALTH PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-457-0085
Mailing Address - Street 1:575 E MAPLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2827
Mailing Address - Country:US
Mailing Address - Phone:248-457-0085
Mailing Address - Fax:248-457-0086
Practice Address - Street 1:575 E MAPLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2827
Practice Address - Country:US
Practice Address - Phone:248-457-0085
Practice Address - Fax:248-457-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052024261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF00477Medicare UPIN