Provider Demographics
NPI:1689239683
Name:MOTOR CITY MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MOTOR CITY MEDICAL GROUP PLLC
Other - Org Name:MOTOR CITY TMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGROU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-703-1869
Mailing Address - Street 1:1300 BROADWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226
Mailing Address - Country:US
Mailing Address - Phone:586-335-2006
Mailing Address - Fax:586-279-3886
Practice Address - Street 1:1300 BROADWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226
Practice Address - Country:US
Practice Address - Phone:313-680-3799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty