Organization
BICOUNTY MEDICAL PRACTICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY DAVENPORT (OPERATIONS MANAGER)
(810) 720-5715
Entity
Organization
Contact information
Practice address
13355 E 10 MILE RD, WARREN, MI 48089-2048
(586) 759-7510
(586) 759-7791
Mailing address
PO BOX 673915, DETROIT, MI 48267-3671
(586) 759-7510
(586) 759-7791
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E000820
BCBSM/BCN
MI
Enumeration date
10/18/2006
Last updated
05/26/2010
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