Provider Demographics
NPI:1780173971
Name:PREMIER MEDICAL DEVELOPMENT
Entity type:Organization
Organization Name:PREMIER MEDICAL DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANZOUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:JALLOUQA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-220-8411
Mailing Address - Street 1:29155 NORTHWESTERN HWY STE 428
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29155 NORTHWESTERN HWY STE 428
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1011
Practice Address - Country:US
Practice Address - Phone:877-220-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies