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27776 Woodward Ave Royal Oak MI 48067-0930 | |
| (248) 556-4900 | |
| (248) 556-4950 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 27776 Woodward Ave, Royal Oak, Michigan |
| Authorized Official Name and Position | Joslyn Pettway (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3135540485 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
559 W Grand Blvd Detroit MI 48216-2200 Ph: (313) 554-0485 | 27776 Woodward Ave Royal Oak MI 48067-0930 Ph: (248) 556-4900 |
| NPI Number | 1073834818 |
|---|---|
| Provider Enumeration Date | 06/16/2010 |
| Last Update Date | 05/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073834818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4704195855 (Michigan) | Primary |
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