Provider Demographics
NPI:1871847640
Name:RELIANCE MEDICAL GROUP - DETROIT
Entity Type:Organization
Organization Name:RELIANCE MEDICAL GROUP - DETROIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-1282
Mailing Address - Street 1:6420 FARMINGTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2276
Mailing Address - Country:US
Mailing Address - Phone:248-203-1282
Mailing Address - Fax:248-203-4148
Practice Address - Street 1:6420 FARMINGTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2276
Practice Address - Country:US
Practice Address - Phone:248-203-1282
Practice Address - Fax:248-203-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208D00000X
MI207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty