Organization
BI COUNTY CLINICAL PRACTICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KIBBLE (DIRECTOR)
(313) 874-3436
Entity
Organization
Contact information
Practice address
27500 HOOVER RD, STE 100, WARREN, MI 48093-4586
(586) 754-2558
(586) 754-2426
Mailing address
PO BOX 673195, DETROIT, MI 48267-0001
(810) 720-5715
(810) 732-0891
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E002070
BCBSM/BCN
MI
Enumeration date
09/14/2007
Last updated
10/14/2010
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