Provider Demographics
NPI:1023216165
Name:BLESSED MC, LLC.
Entity type:Organization
Organization Name:BLESSED MC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-772-0406
Mailing Address - Street 1:34441 8 MILE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:313-772-0406
Mailing Address - Fax:
Practice Address - Street 1:34441 8 MILE RD
Practice Address - Street 2:STE 104
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:313-772-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty