Provider Demographics
NPI:1801506381
Name:OMT MI PC
Entity type:Organization
Organization Name:OMT MI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-994-1816
Mailing Address - Street 1:38525 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1012
Mailing Address - Country:US
Mailing Address - Phone:586-994-1816
Mailing Address - Fax:
Practice Address - Street 1:38525 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1012
Practice Address - Country:US
Practice Address - Phone:586-994-1816
Practice Address - Fax:734-542-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty