Organization
ACTIVATE HEALTHCARE MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA A. GEIHSLER (PRINCIPAL)
(773) 697-3144
Entity
Organization
Contact information
Practice address
555 HORACE BROWN DR, SUITE 200, MADISON HEIGHTS, MI 48071-1867
(773) 697-3144
Mailing address
2115 N DAMEN AVE, 2ND FLOOR, CHICAGO, IL 60647-4528
(773) 697-3144
(773) 697-1437
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
APPLYING FOR
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APPLYING FOR
MEDICARE PTAN
MI
Enumeration date
04/01/2014
Last updated
04/01/2014
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