Basic Information
| Provider Information | |||||||||
| NPI: | 1548497167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB & GYN ASSOCIATE PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 S. TELEGRAPH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483359207 | ||||||||
| FaxNumber: | 2483352394 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 S. TELEGRAPH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483359207 | ||||||||
| FaxNumber: | 2483352394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | TELESFORO | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2483359207 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 4301081848 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1336357219 | 05 | MI | MEDICAID | 1336357219 | 01 | MI | CIGNA | OTHER |