Organization
ALPHA AND OMEGA PRIMARY HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICKIE HARDAWAY M.D. (OWNER)
(313) 342-2576
Entity
Organization
Contact information
Practice address
15865 WYOMING ST, DETROIT, MI 48238-1136
(313) 342-2576
Mailing address
15865 WYOMING ST, DETROIT, MI 48238-1136
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301061729
MI
208000000X
Pediatrics Physician
4301061729
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316903198
—
MI
Enumeration date
02/27/2008
Last updated
04/29/2008
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