Provider Demographics
NPI:1700866811
Name:PHYSICIANS RESIDENTIAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PHYSICIANS RESIDENTIAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOLER-VALCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-8801
Mailing Address - Street 1:20927 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3128
Mailing Address - Country:US
Mailing Address - Phone:586-777-8801
Mailing Address - Fax:586-777-9988
Practice Address - Street 1:20927 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3128
Practice Address - Country:US
Practice Address - Phone:586-777-8801
Practice Address - Fax:586-777-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
010E010070OtherBCBSM
P00405274OtherRAILROAD MEDICARE
MI104784286Medicaid
010066340OtherRAILROAD MEDICARE
MI104676117Medicaid
P00298680OtherRAILROAD MEDICARE
MI135198828Medicaid
MI104676117Medicaid