Provider Demographics
NPI:1821002734
Name:MICHIGAN SERVICES NETWORK INC
Entity Type:Organization
Organization Name:MICHIGAN SERVICES NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-459-5499
Mailing Address - Street 1:31 OAKLAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2019
Mailing Address - Country:US
Mailing Address - Phone:313-459-5499
Mailing Address - Fax:501-636-5236
Practice Address - Street 1:31 OAKLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2019
Practice Address - Country:US
Practice Address - Phone:313-459-5499
Practice Address - Fax:501-636-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty