Provider Demographics
NPI:1518005800
Name:AGY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:AGY MEDICAL GROUP PC
Other - Org Name:FARMINGTON HILLS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSIB
Authorized Official - Middle Name:
Authorized Official - Last Name:GAPPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-626-1999
Mailing Address - Street 1:27970 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3767
Mailing Address - Country:US
Mailing Address - Phone:248-626-1999
Mailing Address - Fax:248-626-1889
Practice Address - Street 1:27970 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3767
Practice Address - Country:US
Practice Address - Phone:248-626-1999
Practice Address - Fax:248-626-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMG057989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F0367600OtherBC/BS
MI110F0367600OtherBC/BS
MII18133Medicare UPIN
MIG27715Medicare UPIN
MIMI1278Medicare PIN
MIG54089Medicare UPIN