Organization
GENERAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MARK PROSE M.D. (PRESIDENT)
(248) 662-0250
Entity
Organization
Contact information
Practice address
21333 HAGGERTY RD, SUITE 150, NOVI, MI 48375-5510
(248) 662-0250
(248) 662-9844
Mailing address
21333 HAGGERTY RD, SUITE 150, NOVI, MI 48375-5510
(248) 662-0250
(248) 662-9844
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
MI
363L00000X
Nurse Practitioner
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09830139
BLUE CROSS/BLUE SHIELD
IL
05
—
1452653
—
LA
01
—
500F329520
BLUE CROSS/BLUE SHIELD
MI
05
—
506127307
—
MO
01
—
CB2699
METRAHEALTH RR
IL
01
—
CC4797
METRAHEALTH RR
MI
01
—
DA1347
METRAHEALTH RR
MI
Enumeration date
05/05/2006
Last updated
09/16/2015
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