Provider Demographics
NPI:1942391768
Name:PLYMOUTH CANTON MEDICAL CENTER
Entity Type:Organization
Organization Name:PLYMOUTH CANTON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TUASON
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-459-0700
Mailing Address - Street 1:7321 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2457
Mailing Address - Country:US
Mailing Address - Phone:734-459-0700
Mailing Address - Fax:734-459-1019
Practice Address - Street 1:7321 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2457
Practice Address - Country:US
Practice Address - Phone:734-459-0700
Practice Address - Fax:734-459-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01-08282852OtherBCBS PROVDER #
MIA74805Medicare UPIN
MI0828285Medicare ID - Type UnspecifiedMEDICARE PROVIDER #