Basic Information
| Provider Information | |||||||||
| NPI: | 1093085441 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPMG DOWNRIVER PLLC | ||||||||
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| Address1: | 2000 GREEN RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051598 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2333 BIDDLE AVE | ||||||||
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| City: | WYANDOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481924668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694012386 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2012 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.