Organization
MILLENNIUM MEDICAL GROUP SOUTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABRAHAM SLAIM D.O. (PRESIDENT)
(313) 538-3099
Entity
Organization
Contact information
Practice address
9340 TELEGRAPH RD, TAYLOR, MI 48180-3362
(313) 295-3388
(313) 295-4198
Mailing address
25241 GRAND RIVER AVE, REDFORD, MI 48240-1404
(313) 538-3099
(313) 538-3282
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207UN0902X
Nuclear Imaging & Therapy Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500H255490
BLUE SHIELD
MI
01
—
700H222490
BLUE SHIELD GROUP
MI
01
—
DD9487
MEDICARE ID TYPE UNSPECIFIED
MI
Enumeration date
06/25/2006
Last updated
08/19/2008
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