Organization
MICHIGAN INFUSION SERVICES AND LICENSED HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY L LONG PA-C (ASSOCIATE MEDICAL DIRECTOR)
(734) 341-7767
Entity
Organization
Contact information
Practice address
500 ROSS ST, PLYMOUTH, MI 48170-2206
(734) 341-7767
Mailing address
500 ROSS ST, PLYMOUTH, MI 48170-2206
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
05/11/2022
Last updated
06/23/2022
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