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Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr
Clinic/Center in Southfield, Michigan
NPI 1851583215

Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr is a Clinic/Center based in Southfield, MI. Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr practices in Southfield, MI. The NPI Number for Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr is 1851583215 and holds a License No. 4301039079 (Michigan).

The current practice location address for Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr is 17650 W 12 Mile Rd, Southfield, MI and can be reached out via phone at 313-871-9940. You can also correspond with Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr through the mailing address at 17650 W 12 MILE RD, SOUTHFIELD, MI - 48076-1911 (mailing address contact number: 313-871-9940).

Location: 17650 W 12 Mile Rd, Southfield, MI, 48076-1911
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1851583215
Provider Name
Tyrone Chatman Etal Ptr Martrilla Ross Gen Ptr
Credential
Provider Entity Type
Organization
Address
17650 W 12 Mile Rd, Southfield, MI, 48076-1911
Phone Number
313-871-9940
Fax Number
Provider Enumeration Date
08/09/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1851583215 01 MI NPI
1891701884 01 MI NPI
OM83260 01 MI MEDICARE
institution
Provider Business Practice Location Address Details
Address
17650 W 12 Mile Rd
City
Southfield
State
Michigan
Zip
48076-1911
Phone Number
313-871-9940
Fax Number
person
Provider Business Mailing Address Details
Address
17650 W 12 Mile Rd
City
Southfield
State
Michigan
Zip
48076-1911
Phone Number
313-871-9940
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
4301039079 (Michigan)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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