Organization
MED SOURCE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE DIXON (PRACTICE MANAGER)
(248) 746-0882
Entity
Organization
Contact information
Practice address
24901 NORTHWESTERN HWY, SUITE 205, SOUTHFIELD, MI 48075-2203
(248) 748-0882
(248) 357-2380
Mailing address
24901 NORTHWESTERN HWY, SUITE 205, SOUTHFIELD, MI 48075-2203
(248) 748-0882
(248) 357-2380
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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