Provider Demographics
NPI:1417346032
Name:THE MEDICAL TEAM
Entity Type:Organization
Organization Name:THE MEDICAL TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OCCUPATIONAL THERAPY ASST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:COTAL
Authorized Official - Phone:734-283-2742
Mailing Address - Street 1:17622 VALADE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-4721
Mailing Address - Country:US
Mailing Address - Phone:734-283-2742
Mailing Address - Fax:
Practice Address - Street 1:17197 N LAUREL PARK DR STE 555
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2686
Practice Address - Country:US
Practice Address - Phone:734-779-9700
Practice Address - Fax:734-779-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007380310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility