Provider Demographics
NPI:1851554497
Name:REGIONAL TRAUMA CARE PC
Entity Type:Organization
Organization Name:REGIONAL TRAUMA CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-543-8070
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-543-8070
Mailing Address - Fax:248-543-9005
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:TRAUMA SERVICES
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-3814
Practice Address - Fax:586-493-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty