Provider Demographics
NPI:1427410018
Name:METRO MEDICAL HAGGERTY PARTNERS PA
Entity Type:Organization
Organization Name:METRO MEDICAL HAGGERTY PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-662-0250
Mailing Address - Street 1:21333 HAGGERTY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5510
Mailing Address - Country:US
Mailing Address - Phone:248-662-0250
Mailing Address - Fax:248-662-9845
Practice Address - Street 1:21333 HAGGERTY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5510
Practice Address - Country:US
Practice Address - Phone:248-662-0250
Practice Address - Fax:248-662-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty