Basic Information
| Provider Information | |||||||||
| NPI: | 1841367729 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATIONS OB GYN CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2484331742 | ||||||||
| Practice Location | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 07/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | SANBORN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2486479860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.