Basic Information
| Provider Information | |||||||||
| NPI: | 1881105039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEAUMONT MEDICAL GROUP- SPECIALTY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26901 BEAUMONT BOULEVARD | ||||||||
| Address2: | STE. 3D | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480333849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9475221857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6900 ORCHARD LAKE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483223424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488985000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | MANER | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VP, BEAUMONT PHYSICIAN PARTNERS | ||||||||
| AuthorizedOfficialTelephone: | 9475221912 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.