Provider Demographics
NPI:1285232322
Name:CANTON OB-GYN GROUP P.L.C.
Entity type:Organization
Organization Name:CANTON OB-GYN GROUP P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OB/GYN
Authorized Official - Prefix:
Authorized Official - First Name:LIJIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-717-1501
Mailing Address - Street 1:50475 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4441
Mailing Address - Country:US
Mailing Address - Phone:313-717-1501
Mailing Address - Fax:
Practice Address - Street 1:2050 N HAGGERTY RD STE 140
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3796
Practice Address - Country:US
Practice Address - Phone:734-306-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285232322Medicaid