Provider Demographics
NPI:1548497167
Name:OB & GYN ASSOCIATE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:OB & GYN ASSOCIATE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TELESFORO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-9207
Mailing Address - Street 1:2520 S. TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0302
Mailing Address - Country:US
Mailing Address - Phone:248-335-9207
Mailing Address - Fax:248-335-2394
Practice Address - Street 1:2520 S. TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0302
Practice Address - Country:US
Practice Address - Phone:248-335-9207
Practice Address - Fax:248-335-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081848207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336357219Medicaid
MI1336357219OtherCIGNA
MI1336357219OtherCIGNA