Basic Information
| Provider Information | |||||||||
| NPI: | 1265543318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OBGAP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 WARNER DR | ||||||||
| Address2: | |||||||||
| City: | W BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483242445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483607797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2520 S TELEGRAPH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483359207 | ||||||||
| FaxNumber: | 2483352394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | TELESFORO | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2483359207 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 430103648 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 10-4520161 | 05 | MI | MEDICAID | 10-4170054 | 05 | MI | MEDICAID | 10-4609965 | 05 | MI | MEDICAID | 104170036 | 05 | MI | MEDICAID | 10-4170027 | 05 | MI | MEDICAID |