Organization
EXECUTIVE DIAGNOSTIC GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS C JORGE MD (OWNER)
(313) 359-9361
Entity
Organization
Contact information
Practice address
1711 MONROE ST, DEARBORN, MI 48124-2914
(313) 359-9361
(313) 436-1767
Mailing address
1711 MONROE ST, DEARBORN, MI 48124-2914
(313) 359-9361
(313) 436-1767
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
4301038699
MI
Other
Enumeration date
06/05/2012
Last updated
09/18/2014
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