| East Park Medical Center | |
|
4821 Mcnichols St Detroit MI 48212-1730 | |
| (313) 368-4600 | |
| (313) 368-4700 |
| Full Name | East Park Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 4821 Mcnichols St, Detroit, Michigan |
| Authorized Official Name and Position | Sai Wentum (CEO) |
| Authorized Official Contact | 3133684600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Park Medical Center 4821 Mcnichols St Detroit MI 48212-1730 Ph: (313) 368-4600 | East Park Medical Center 4821 Mcnichols St Detroit MI 48212-1730 Ph: (313) 368-4600 |
| NPI Number | 1053462846 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 05/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053462846 | NPI | - | NPPES |
| 4529149 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 049430 (Michigan) | Primary |
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