# MY VISITING PHYSICIANS PC

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

## Provider details

- **NPI number:** 1740512201
- **Authorized official:** JONATHAN AGBEBIYI M.D. (OWNER)
- **Authorized official phone:** (248) 946-2050

## Contact information

- **Practice address:** 20755 GREENFIELD RD, SUITE 100A, SOUTHFIELD, MI 48075
- **Practice address phone:** (248) 946-2050
- **Mailing address:** 20755 GREENFIELD RD, SUITE 100A, SOUTHFIELD, MI 48075
- **Mailing address phone:** (248) 946-2050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | 4301041053 | MI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 4301041053 | MI | — |
| 208D00000X | General Practice Physician | 4301041053 | MI | Yes |

## Other

- **Enumeration date:** 02/09/2010
- **Last updated:** 04/29/2011