Provider Demographics
NPI:1477813947
Name:SUMMIT VISITING PHYSICIANS GROUP
Entity Type:Organization
Organization Name:SUMMIT VISITING PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-562-0883
Mailing Address - Street 1:8560 N SILVERY LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4515
Mailing Address - Country:US
Mailing Address - Phone:313-562-0883
Mailing Address - Fax:313-562-0885
Practice Address - Street 1:8560 N SILVERY LN
Practice Address - Street 2:SUITE 204
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4515
Practice Address - Country:US
Practice Address - Phone:313-562-0883
Practice Address - Fax:313-562-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT PHYSICIANS GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty