Provider Demographics
NPI:1952529091
Name:ALEX PICKENS & ASSOC M D P C
Entity type:Organization
Organization Name:ALEX PICKENS & ASSOC M D P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:M,D,
Authorized Official - Phone:313-272-2400
Mailing Address - Street 1:PO BOX 23518
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-0518
Mailing Address - Country:US
Mailing Address - Phone:313-272-2400
Mailing Address - Fax:313-535-9060
Practice Address - Street 1:15639 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3541
Practice Address - Country:US
Practice Address - Phone:313-272-2400
Practice Address - Fax:313-535-9060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEX PICKENS & ASSOC M D P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038348207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE16044Medicare UPIN
MI3821064Medicare ID - Type Unspecified