Provider Demographics
NPI:1952866808
Name:MAIN STREET PHYSICIANS P.C.
Entity Type:Organization
Organization Name:MAIN STREET PHYSICIANS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-676-3373
Mailing Address - Street 1:25000 HALL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5112
Mailing Address - Country:US
Mailing Address - Phone:734-676-3373
Mailing Address - Fax:734-676-2014
Practice Address - Street 1:25000 HALL RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5112
Practice Address - Country:US
Practice Address - Phone:734-676-3373
Practice Address - Fax:734-676-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty