Provider Demographics
NPI:1790950186
Name:WOMEN'S CENTER HEALTHCARE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:WOMEN'S CENTER HEALTHCARE PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-388-4247
Mailing Address - Street 1:25050 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1297
Mailing Address - Country:US
Mailing Address - Phone:313-388-4247
Mailing Address - Fax:313-388-4827
Practice Address - Street 1:25050 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1297
Practice Address - Country:US
Practice Address - Phone:313-388-4247
Practice Address - Fax:313-388-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty