| Ga Visiting Providers, Pllc | |
|
3212 Winchester Rd West Bloomfield MI 48322-2420 | |
| (248) 763-8266 | |
| Not Available |
| Full Name | Ga Visiting Providers, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3212 Winchester Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Jolene Kassab (PART-OWNER) |
| Authorized Official Contact | 2487638266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ga Visiting Providers, Pllc 3212 Winchester Rd West Bloomfield MI 48322-2420 Ph: () - | Ga Visiting Providers, Pllc 3212 Winchester Rd West Bloomfield MI 48322-2420 Ph: (248) 763-8266 |
| NPI Number | 1639869860 |
|---|---|
| Provider Enumeration Date | 05/10/2023 |
| Last Update Date | 05/10/2023 |
| Medicare PECOS PAC ID | 4981052545 |
|---|---|
| Medicare Enrollment ID | O20231121002207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639869860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Adrian Michel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851955777 PECOS PAC ID: 2668715004 Enrollment ID: I20220817003689 |
| Provider Name | Jolene Kassab |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508442880 PECOS PAC ID: 5496112310 Enrollment ID: I20230608002123 |
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