Provider Demographics
NPI:1487826020
Name:ALBERT A. PRZYBYLSKI, D.O, PC
Entity Type:Organization
Organization Name:ALBERT A. PRZYBYLSKI, D.O, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PRZYBYLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-791-3150
Mailing Address - Street 1:36549 HARPER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2012
Mailing Address - Country:US
Mailing Address - Phone:586-791-3150
Mailing Address - Fax:586-791-0409
Practice Address - Street 1:36549 HARPER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2012
Practice Address - Country:US
Practice Address - Phone:586-791-3150
Practice Address - Fax:586-791-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4361360Medicaid
MI0N37010Medicare PIN
MI4361360Medicaid