Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 22, 2017
License(s)
5101025222 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 18207 GOULD CT | Beverly Hills, MI 48025-5451 | 248-219-3762 |
| LOCATION | 32270 TELEGRAPH RD STE 240 | Bingham Farms, MI 48025-2457 | 248-548-3060 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.