# PERRY MLK MEDICAL CENTER P.C.

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

## Provider details

- **NPI number:** 1407942394
- **Authorized official:** DR. BRYAN K SWILLEY DO (PRESIDENT)
- **Authorized official phone:** (248) 338-2793

## Contact information

- **Practice address:** 673 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1627
- **Practice address phone:** (248) 338-2793
- **Mailing address:** 673 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1627
- **Mailing address phone:** (248) 338-2793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | BS010362 | MI | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 10/26/2010

## 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 |