Provider Demographics
NPI:1942467378
Name:JOHN W. ARMSTEAD M.D. PC
Entity Type:Organization
Organization Name:JOHN W. ARMSTEAD M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-326-5000
Mailing Address - Street 1:4020 VENOY RD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1891
Mailing Address - Country:US
Mailing Address - Phone:734-326-5000
Mailing Address - Fax:734-326-0102
Practice Address - Street 1:4020 VENOY RD.
Practice Address - Street 2:SUITE 400
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1891
Practice Address - Country:US
Practice Address - Phone:734-326-5000
Practice Address - Fax:734-326-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJA050190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2654999Medicaid
MI2654999Medicaid