Provider Demographics
NPI:1871181537
Name:HEALTH MANAGEMENT CENTER OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:HEALTH MANAGEMENT CENTER OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GASPAR
Authorized Official - Last Name:MADURO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-439-0557
Mailing Address - Street 1:808 LIVERNOIS ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2309
Mailing Address - Country:US
Mailing Address - Phone:248-439-0557
Mailing Address - Fax:
Practice Address - Street 1:808 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2309
Practice Address - Country:US
Practice Address - Phone:248-439-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty