Provider Demographics
NPI:1750334363
Name:METRO OBSTETRICS & GYNECOLOGY PC
Entity type:Organization
Organization Name:METRO OBSTETRICS & GYNECOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-360-9090
Mailing Address - Street 1:8391 COMMERCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-360-9090
Mailing Address - Fax:248-360-9093
Practice Address - Street 1:8391 COMMERCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-9090
Practice Address - Fax:248-360-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043155207V00000X
MI4301043920207V00000X
MI4301041023207V00000X
MI4301053025207V00000X
MI430105101013792207V00000X
MI4301039104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M95880Medicare PIN