Provider Demographics
NPI:1508892951
Name:PROGRESSIVE GUIDANCE CENTER OF MONROE PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE GUIDANCE CENTER OF MONROE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-241-4851
Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-241-4851
Mailing Address - Fax:734-241-6552
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-241-4851
Practice Address - Fax:734-241-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP26050Medicare ID - Type Unspecified