| Patrick A. Charles MD PC | |
|
18601 Mack Ave Detroit MI 48236-3250 | |
| (313) 640-1250 | |
| (313) 640-1291 |
| Full Name | Patrick A. Charles MD PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 18601 Mack Ave, Detroit, Michigan |
| Authorized Official Name and Position | Patrick Anselm Charles (PRESIDENT) |
| Authorized Official Contact | 3136401250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patrick A. Charles MD PC Po Box 21158 Detroit MI 48221-0158 Ph: (313) 640-1250 | Patrick A. Charles MD PC 18601 Mack Ave Detroit MI 48236-3250 Ph: (313) 640-1250 |
| NPI Number | 1205878824 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 12/18/2007 |
| Medicare PECOS PAC ID | 0840202644 |
|---|---|
| Medicare Enrollment ID | O20060616000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205878824 | NPI | - | NPPES |
| 2876665 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301058495 (Michigan) | Primary |
| Provider Name | Borivoje M Trifunovic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730167644 PECOS PAC ID: 6507899671 Enrollment ID: I20050919000293 |
| Provider Name | Patrick a Charles |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396742151 PECOS PAC ID: 8921025396 Enrollment ID: I20060616000260 |
| Provider Name | Savannah Shephard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518425610 PECOS PAC ID: 2264914233 Enrollment ID: I20260309000174 |
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