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Organization
PROVIDENCE
Active
Organization
PROVIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORY ZACHARY TRIVAX (RESIDENT)
(248) 417-4092
Entity
Organization
Contact information
Practice address
662 PURDY ST, UNIT 214, BIRMINGHAM, MI 48009-1731
(248) 417-4092
Mailing address
662 PURDY ST, UNIT 214, BIRMINGHAM, MI 48009-1731
(248) 417-4092
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Enumeration date
04/06/2007
Last updated
08/22/2020
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