Organization
BI COUNTY MEDICAL PRACTICES
Active
Organization
BI COUNTY MEDICAL PRACTICES
Active
Other names
Henry Ford Macomb Hospital Warren
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY GOODBALIAN (CFO)
(586) 263-2705
Entity
Organization
Contact information
Practice address
27500 HOOVER RD, WARREN, MI 48093-4586
(586) 755-1606
(586) 755-1857
Mailing address
PO BOX 673195, DETROIT, MI 48267-3195
(810) 720-5715
(810) 732-0891
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100E009930
BCBSM/BCN
MI
01
—
700E000820
BCBSM/BCN
MI
Enumeration date
03/24/2010
Last updated
06/17/2010
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