# MEDICINA URBANA WEST VERNOR PLLC

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

## Provider details

- **NPI number:** 1740793777
- **Authorized official:** MARK RYAN BEARD DO (MEMBER)
- **Authorized official phone:** (313) 281-1362

## Contact information

- **Practice address:** 5700 W VERNOR HWY, DETROIT, MI 48209
- **Practice address phone:** (313) 586-3066
- **Practice address fax:** (313) 586-3165
- **Mailing address:** 5700 W VERNOR HWY, DETROIT, MI 48209-2158
- **Mailing address phone:** (313) 586-7481
- **Mailing address fax:** (313) 899-7392

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 5101017883 | MI | Yes |

## Other

- **Enumeration date:** 11/13/2017
- **Last updated:** 05/15/2018