Provider Demographics
NPI:1518171073
Name:MAYWOOD MEDICAL AND INDUSTRIAL CLINIC, INC.
Entity Type:Organization
Organization Name:MAYWOOD MEDICAL AND INDUSTRIAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-242-9000
Mailing Address - Street 1:811 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3078
Mailing Address - Country:US
Mailing Address - Phone:734-243-2300
Mailing Address - Fax:734-243-2490
Practice Address - Street 1:811 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3078
Practice Address - Country:US
Practice Address - Phone:734-243-2300
Practice Address - Fax:734-243-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT34116Medicare UPIN
MI0580069Medicare PIN
MIA74688Medicare UPIN
MI8585008Medicare PIN