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Organization
KANCC MEDICAL PLC
Active
Organization
KANCC MEDICAL PLC
Active
Other names
Kancc Medical
Organization subpart
No
Provider details
NPI number
Authorized official
PETER R NWOKE M.D (OWNER)
(313) 473-8525
Entity
Organization
Contact information
Practice address
17331 MACK AVE, DETROIT, MI 48224-2250
(313) 473-8525
(313) 473-8521
Mailing address
PO BOX 806464, SAINT CLAIR SHORES, MI 48080-6464
(313) 473-8525
(313) 473-8521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
Other
Enumeration date
06/28/2019
Last updated
07/18/2022
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