Organization
ACADIAN SUPREME HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INGRID N. LEWIS (AUTHORIZED OFFICIAL/FNP)
(313) 930-0258
Entity
Organization
Contact information
Practice address
12866 FORT ST, SOUTHGATE, MI 48195-1060
(313) 930-0258
Mailing address
20831 RIDGEMONT RD, HARPER WOODS, MI 48225-1137
(313) 930-0258
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
09/12/2020
Last updated
09/12/2020
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