Organization
ASSOCIATED GENERAL PRACTICE NETWORK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. INDIRA DESIKACHAR (MEMBER)
(248) 231-8542
Entity
Organization
Contact information
Practice address
11803 GRAND RIVER AVE, DETROIT, MI 48204-1810
(313) 491-5544
(248) 485-6631
Mailing address
30345 RUSHMORE CIR, FRANKLIN, MI 48025-1510
(248) 231-8542
(248) 485-6631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-0-H2-3914-0
BCBS
MI
Enumeration date
05/02/2008
Last updated
10/24/2014
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