Provider Demographics
NPI:1659310613
Name:WOMENS CARE OF DETROIT PLLC 2
Entity Type:Organization
Organization Name:WOMENS CARE OF DETROIT PLLC 2
Other - Org Name:UWC REPRODUCTIVE ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:313-993-4513
Mailing Address - Street 1:26400 W 12 MILE RD
Mailing Address - Street 2:STE 140
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1700
Mailing Address - Country:US
Mailing Address - Phone:248-352-8200
Mailing Address - Fax:248-356-8255
Practice Address - Street 1:3750 WOODWARD AVE
Practice Address - Street 2:STE 200 B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2007
Practice Address - Country:US
Practice Address - Phone:313-993-4538
Practice Address - Fax:313-993-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M68390Medicare ID - Type Unspecified