Provider Demographics
NPI:1730325549
Name:MASCOT MEDICAL CONSULTANTS PLLC
Entity type:Organization
Organization Name:MASCOT MEDICAL CONSULTANTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MASCOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-534-0300
Mailing Address - Street 1:1800 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3545
Mailing Address - Country:US
Mailing Address - Phone:248-649-2323
Mailing Address - Fax:248-649-5998
Practice Address - Street 1:1800 W BIG BEAVER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3545
Practice Address - Country:US
Practice Address - Phone:248-649-2323
Practice Address - Fax:248-649-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty