Provider Demographics
NPI:1629730353
Name:DYNAMIC MANAGEMENT GROUP, LLC
Entity Type:Organization
Organization Name:DYNAMIC MANAGEMENT GROUP, LLC
Other - Org Name:DYNAMIC HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:586-585-6500
Mailing Address - Street 1:33464 SCHOENHERR RD STE 160
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6392
Mailing Address - Country:US
Mailing Address - Phone:586-585-6500
Mailing Address - Fax:586-585-6852
Practice Address - Street 1:33464 SCHOENHERR RD STE 160
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6392
Practice Address - Country:US
Practice Address - Phone:586-585-6500
Practice Address - Fax:586-585-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty