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Organization
NILES PROFESSIONAL SERVICES, INC
Active
Organization
NILES PROFESSIONAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS MACK (VICE PRESIDENT FACILITY DEVELOPMENT)
(269) 684-0259
Entity
Organization
Contact information
Practice address
122 GRANT ST, NILES, MI 49120-2281
(269) 684-2411
(269) 684-0189
Mailing address
122 GRANT ST, NILES, MI 49120-2281
(269) 684-2411
(269) 684-0189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB0012
RAILROAD MEDICARE
—
Enumeration date
06/18/2006
Last updated
11/20/2007
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