| Perry Mlk Medical Center P.c. | |
|
673 Martin Luther King Jr Blvd N Pontiac MI 48342-1627 | |
| (248) 338-2793 | |
| Not Available |
| Full Name | Perry Mlk Medical Center P.c. |
|---|---|
| Speciality | General Practice |
| Location | 673 Martin Luther King Jr Blvd N, Pontiac, Michigan |
| Authorized Official Name and Position | Bryan K Swilley (PRESIDENT) |
| Authorized Official Contact | 2483382793 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perry Mlk Medical Center P.c. 673 Martin Luther King Jr Blvd N Pontiac MI 48342-1627 Ph: (248) 338-2793 | Perry Mlk Medical Center P.c. 673 Martin Luther King Jr Blvd N Pontiac MI 48342-1627 Ph: (248) 338-2793 |
| NPI Number | 1407942394 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 10/26/2010 |
| Medicare PECOS PAC ID | 5395937353 |
|---|---|
| Medicare Enrollment ID | O20101008000348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407942394 | NPI | - | NPPES |
| 0856308604 | Other | MI | BCBS OF MI |
| 000000001401 | Other | MI | CAPE HEALTH PLAN |
| 114402195 | Medicaid | MI | |
| 132616 | Other | MI | CARE CHOICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | BS010362 (Michigan) | Primary |
| Provider Name | Bryan Swilley |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1861409302 PECOS PAC ID: 6204028269 Enrollment ID: I20101026000874 |
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