# MMG 1PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTHWEST INTERNAL MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215103940
- **Authorized official:** DR. GEOFFREY A. TRIVAX M.D. (PRESIDENT)
- **Authorized official phone:** (248) 851-1430

## Contact information

- **Practice address:** 28625 NORTHWESTERN HWY, SUITE 213, SOUTHFIELD, MI 48034-1828
- **Practice address phone:** (248) 354-9666
- **Practice address fax:** (248) 354-3653
- **Mailing address:** 29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
- **Mailing address phone:** (248) 851-1430
- **Mailing address fax:** (248) 851-5182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 05/02/2008
- **Last updated:** 09/20/2018