Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
May 30, 2019
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 25631 LITTLE MACK AVE STE 104 | Saint Clair Shores, MI 48081-2100 | 586-884-2727 |
| MAILING | 259 MACK AVE STE 2590 | Detroit, MI 48201-2427 |
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.