| John R Medical Clinic, Pc | |
|
26505 John R Rd Madison Heights MI 48071-3611 | |
| (248) 547-3100 | |
| (248) 547-4733 |
| Full Name | John R Medical Clinic, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 26505 John R Rd, Madison Heights, Michigan |
| Authorized Official Name and Position | James M Kohlenberg (OWNER) |
| Authorized Official Contact | 2485473100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John R Medical Clinic, Pc 26505 John R Rd Madison Heights MI 48071-3611 Ph: (248) 547-3100 | John R Medical Clinic, Pc 26505 John R Rd Madison Heights MI 48071-3611 Ph: (248) 547-3100 |
| NPI Number | 1225108343 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 01/14/2010 |
| Medicare PECOS PAC ID | 0143324095 |
|---|---|
| Medicare Enrollment ID | O20070402000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225108343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Habib Georgi Gennaoui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437140225 PECOS PAC ID: 9133139538 Enrollment ID: I20060501000097 |
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