Basic Information
| Provider Information | |||||||||
| NPI: | 1427369743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DMC BILLING ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673671 | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107205715 | ||||||||
| FaxNumber: | 8107320891 | ||||||||
| Practice Location | |||||||||
| Address1: | 5635 W MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | W BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483223714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486262803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | PLUE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT/BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8107205715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.