Organization
IMHOTEP MEDICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONNIE L MITCHELL M.D. (OWNER, PHYSICIAN)
(313) 701-1187
Entity
Organization
Contact information
Practice address
5525 GREENWAY ST, DETROIT, MI 48204-2112
(313) 935-0399
(313) 931-9113
Mailing address
5525 GREENWAY ST, SUITE B - 2, DETROIT, MI 48204-2112
(313) 701-1187
(313) 931-9113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4301056553
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4706980
—
MI
Enumeration date
04/06/2007
Last updated
10/06/2014
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