Organization
PROVIDER SERVICE ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMON VILLANUEVA (PRESIDENT)
(734) 516-4239
Entity
Organization
Contact information
Practice address
7233 PROVINCIAL CT, CANTON, MI 48187-2121
(734) 516-4239
(734) 404-5292
Mailing address
7233 PROVINCIAL CT, CANTON, MI 48187-2121
(734) 516-4239
(734) 404-5292
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
02/29/2016
Last updated
06/06/2016
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