Organization
IPS OF DETROIT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL RICHARDSON NOBACK MD (MEMBER)
(941) 360-1566
Entity
Organization
Contact information
Practice address
16100 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1148
(586) 263-7657
Mailing address
201 MONTGOMERY AVE, SARASOTA, FL 34243-1519
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
12/29/2008
Last updated
12/29/2008
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