Provider Demographics
NPI:1548331523
Name:UNIVERSAL MEDICAL PHYSICIANS, P.C.
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANCEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-833-5032
Mailing Address - Street 1:19910 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1811
Mailing Address - Country:US
Mailing Address - Phone:313-863-0053
Mailing Address - Fax:
Practice Address - Street 1:4727 ST. ANTOINE STREET.
Practice Address - Street 2:SUITE 211
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-833-5032
Practice Address - Fax:313-833-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty