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NPI 1780734095 Active Internal Medicine

Quick Facts

NPI Number

1780734095

Type

Organization (NPI-2)

Status

Active

Enumeration Date

2007-01-11

Last Updated (NPPES)

2008-04-25

Primary Specialty / Taxonomy

Taxonomy	Internal Medicine
Taxonomy Code	`207R00000X`
License	4301087179 MI

Other Taxonomies

Family Medicine — License 4301021897

Practice Address

1640 FORT ST
SUITE E
TRENTON, MI 481832040

Phone: 734-675-9888

Fax: 734-675-6775

Mailing Address

15530 KING RD
RIVERVIEW, MI 481937943

Data sourced live from the CMS NPPES NPI Registry (npiregistry.cms.hhs.gov) and cached locally. This is a public directory lookup, not a credentialing or verification service — confirm critical details directly with NPPES or the provider.