Basic Information
| Provider Information | |||||||||
| NPI: | 1982800157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. JOHN MACOMB TOWNSHIP EMERGENCY PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17717 MASONIC | ||||||||
| Address2: | |||||||||
| City: | FRASER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480263158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862940600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17700 23 MILE ROAD | ||||||||
| Address2: | |||||||||
| City: | MACOMB TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864167500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5862940600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.