| Corondan Medical PC Corp | |
|
14050 E 14 Mile Rd Warren MI 48088-5765 | |
| (586) 920-2249 | |
| Not Available |
| Full Name | Corondan Medical PC Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 14050 E 14 Mile Rd, Warren, Michigan |
| Authorized Official Name and Position | Victor I Corondan (OWNER) |
| Authorized Official Contact | 2488379419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corondan Medical PC Corp 14050 E 14 Mile Rd Warren MI 48088-5765 Ph: (586) 920-2249 | Corondan Medical PC Corp 14050 E 14 Mile Rd Warren MI 48088-5765 Ph: (586) 920-2249 |
| NPI Number | 1851715585 |
|---|---|
| Provider Enumeration Date | 02/18/2014 |
| Last Update Date | 04/24/2014 |
| Medicare PECOS PAC ID | 0244463131 |
|---|---|
| Medicare Enrollment ID | O20140430000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851715585 | NPI | - | NPPES |
| 321078 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4301059864 (Michigan) | Primary |
| Provider Name | Victor I Corondan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376594887 PECOS PAC ID: 9234268194 Enrollment ID: I20100602000658 |
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