Provider Demographics
NPI:1780858795
Name:ALLIED MEDICAL GROUP PLC
Entity Type:Organization
Organization Name:ALLIED MEDICAL GROUP PLC
Other - Org Name:OAKWOOD SOUTH CANTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-586-5011
Mailing Address - Street 1:43544 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4572
Mailing Address - Country:US
Mailing Address - Phone:734-981-1206
Mailing Address - Fax:734-981-1299
Practice Address - Street 1:42287 CHERRY HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1975
Practice Address - Country:US
Practice Address - Phone:734-981-1206
Practice Address - Fax:734-981-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty