Provider Demographics
NPI:1457685760
Name:HOME PHYSICIANS GROUP PLLC
Entity Type:Organization
Organization Name:HOME PHYSICIANS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODOR
Authorized Official - Middle Name:ALEXANDRU
Authorized Official - Last Name:DANILIUC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-585-9368
Mailing Address - Street 1:632 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3240
Mailing Address - Country:US
Mailing Address - Phone:248-585-9368
Mailing Address - Fax:248-585-2334
Practice Address - Street 1:632 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3240
Practice Address - Country:US
Practice Address - Phone:248-890-0047
Practice Address - Fax:248-585-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059159208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG45546Medicare UPIN