Basic Information
| Provider Information | |||||||||
| NPI: | 1982636460 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSOCIATED PHYSICIANS OF DEARBORN, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 GREENFIELD RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481264124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139456100 | ||||||||
| FaxNumber: | 3139455260 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 GREENFIELD RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481264124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139456100 | ||||||||
| FaxNumber: | 3139455260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | LOIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3139456100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 700H217510 | 01 | MI | BLUE CROSS | OTHER |