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Organization
PARK PLACE FAMILY PRACTICE & INTERNAL MEDICINE
Active
Organization
PARK PLACE FAMILY PRACTICE & INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN GOSWAMI (OFFICE ADMIN)
(734) 374-0500
Entity
Organization
Contact information
Practice address
12701 TELEGRAPH RD STE 103, TAYLOR, MI 48180-4087
(734) 374-0500
(734) 374-2415
Mailing address
12701 TELEGRAPH RD STE 103, TAYLOR, MI 48180-4087
(734) 374-0500
(734) 374-2415
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891307443
—
MI
01
—
OH62264
BCBSM PIN
MI
Enumeration date
08/17/2020
Last updated
07/21/2021
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