| Largo Glm PLLC | |
|
22101 Moross Rd Detroit MI 48236-2148 | |
| (313) 343-4000 | |
| Not Available |
| Full Name | Largo Glm PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 22101 Moross Rd, Detroit, Michigan |
| Authorized Official Name and Position | Borivoje Trifunovic (PRESIDENT) |
| Authorized Official Contact | 5863545736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Largo Glm PLLC Po Box 36010 Grosse Pointe MI 48236-0010 | Largo Glm PLLC 22101 Moross Rd Detroit MI 48236-2148 Ph: (313) 343-4000 |
| NPI Number | 1902625502 |
|---|---|
| Provider Enumeration Date | 10/09/2024 |
| Last Update Date | 10/09/2024 |
| Certification Date | 10/09/2024 |
| Medicare PECOS PAC ID | 2466989785 |
|---|---|
| Medicare Enrollment ID | O20241227002705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902625502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Borivoje M Trifunovic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730167644 PECOS PAC ID: 6507899671 Enrollment ID: I20050919000293 |
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