Provider Demographics
NPI:1841433588
Name:MICHIGAN VISITING PHYSICIANS PC
Entity type:Organization
Organization Name:MICHIGAN VISITING PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-619-9771
Mailing Address - Street 1:363 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5220
Mailing Address - Country:US
Mailing Address - Phone:248-619-9771
Mailing Address - Fax:
Practice Address - Street 1:25650 OUTER DR
Practice Address - Street 2:SUITE 401
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2096
Practice Address - Country:US
Practice Address - Phone:313-383-7147
Practice Address - Fax:313-383-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty