Organization
EUDEMIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE CANNON (VICE PRESIDENT)
(248) 476-6209
Entity
Organization
Contact information
Practice address
29701 6 MILE RD STE 150A, LIVONIA, MI 48152-8604
(248) 476-6209
Mailing address
37292 CHELSEA CT, FARMINGTON HILLS, MI 48331-2812
(248) 707-0258
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/17/2019
Last updated
10/17/2019
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