# BI COUNTY CLINICAL PRACTICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124213921
- **Authorized official:** JOHN KIBBLE (DIRECTOR)
- **Authorized official phone:** (313) 874-3436

## Contact information

- **Practice address:** 27500 HOOVER RD, STE 100, WARREN, MI 48093-4586
- **Practice address phone:** (586) 754-2558
- **Practice address fax:** (586) 754-2426
- **Mailing address:** PO BOX 673195, DETROIT, MI 48267-0001
- **Mailing address phone:** (810) 720-5715
- **Mailing address fax:** (810) 732-0891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/14/2007
- **Last updated:** 10/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 700E002070 | BCBSM/BCN | MI |