Basic Information
| Provider Information | |||||||||
| NPI: | 1730307315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST OBGYN ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Practice Location | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2007 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOCHMAN | ||||||||
| AuthorizedOfficialFirstName: | LEON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2483539460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1606364391 | 01 | MI | BCBSM | OTHER | 160F319680 | 01 | MI | BCBSM | OTHER | 160F319680 | 01 | MI | BLUE CARE NETWORK | OTHER |