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Organization
PERRY MLK MEDICAL CENTER P.C.
Active
Organization
PERRY MLK MEDICAL CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN K SWILLEY DO (PRESIDENT)
(248) 338-2793
Entity
Organization
Contact information
Practice address
673 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1627
(248) 338-2793
Mailing address
673 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1627
(248) 338-2793
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
BS010362
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000001401
CAPE HEALTH PLAN
MI
01
—
0856308604
BCBS OF MI
MI
05
—
114402195
—
MI
01
—
132616
CARE CHOICES
MI
Enumeration date
10/05/2006
Last updated
10/26/2010
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