Provider Demographics
NPI:1821177163
Name:MEDICAL SERVICES OF DETROIT PC
Entity Type:Organization
Organization Name:MEDICAL SERVICES OF DETROIT PC
Other - Org Name:GREENFIELD MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-569-9523
Mailing Address - Street 1:24261 GREENFIELD RD # A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3117
Mailing Address - Country:US
Mailing Address - Phone:248-569-9523
Mailing Address - Fax:248-569-9529
Practice Address - Street 1:24261 GREENFIELD RD # A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3117
Practice Address - Country:US
Practice Address - Phone:248-569-9523
Practice Address - Fax:248-569-9529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SERVICES OF DETROIT PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086699207Q00000X
MI4301041657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97470Medicare PIN