Provider Demographics
NPI:1629719414
Name:IN HOME PHYSICIAN MANAGEMENT GROUP CO
Entity Type:Organization
Organization Name:IN HOME PHYSICIAN MANAGEMENT GROUP CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRAJLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-414-8890
Mailing Address - Street 1:8411 WORMER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1368
Mailing Address - Country:US
Mailing Address - Phone:313-414-8890
Mailing Address - Fax:
Practice Address - Street 1:8411 WORMER ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1368
Practice Address - Country:US
Practice Address - Phone:313-414-8890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty