PERRY MLK MEDICAL CENTER P.C. (NPI# 1407942394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407942394 |
| Entity Type | Organization |
| Organization Name | PERRY MLK MEDICAL CENTER P.C. |
| Practice Address |
673 Martin Luther King Jr Blvd N Pontiac MI 48342-1627 |
| Practice Telephone | 2483382793 |
| Mailing Telephone | 2483382793 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2010-10-26 |
| Authorized Official Name | DR. BRYAN K SWILLEY (PRESIDENT) |
| Authorized Official Telephone | 2483382793 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | BS010362 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS OF MI | 0856308604 | 01 |
| MI | CAPE HEALTH PLAN | 000000001401 | 01 |
| MI | CARE CHOICES | 132616 | 01 |
| MI | 114402195 | 05 |
| Street Address |
673 MARTIN LUTHER KING JR BLVD N |
| City | PONTIAC |
| State | MI |
| Zip Code | 48342-1627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528589561 | Beloved Home Care LLC. | Home Health | 12 S Mill. St., Apt.314, Pontiac, MI 48342 | 2017-06-29 |
| 1518496942 | Boris Tkach | Student in an Organized Health Care Education/Training Program | 50 N. Perry, Pontiac, MI 48342 | 2017-06-08 |
| 1023547429 | Nicholas James Stepanski | Student in an Organized Health Care Education/Training Program | 50 N. Perry St., Pontiac, MI 48342 | 2017-06-08 |
| 1245769991 | Mecca House Corporation | Assisted Living Facility | 53 West Huron, Pontiac, MI 48342 | 2017-06-07 |
| 1134672868 | Shannon Blaine | Technician, Other | 103 Parkhurst Street, Pontiac, MI 48342 | 2016-07-29 |
| 1669819249 | Bonnie Ann Smith | Occupational Therapist | 60 Parkhurst Dr., Pontiac, MI 48342 | 2013-05-23 |
| 1205123361 | Mary Ellen Kenworthy | Emergency Medicine | 50 North Perry Street, Pontiac, MI 48342 | 2011-07-08 |
| 1740516343 | Nathima Habib Atchoo | Obstetrics & Gynecology | 90 West University, Gary Burnstein Community Health Clinic (free Clinic), Pontiac, MI 48342 | 2009-11-02 |
| 1881824233 | Sylvia Lyn Thompson | Physical Therapist | 900 Auburn Road, Pontiac, MI 48342 | 2009-07-20 |
| 1114154150 | Kyannah Toyann Anderson | Home Health | 175 S.edith St, Pontiac, MI 48342 | 2009-06-17 |
| Find all providers in zip 48342 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962062539 | Healthcare Alliance Pllc | General Practice | 35 S Johnson St Ste 1b, Pontiac, MI 48341-1660 | 2019-06-17 |
| 1922449776 | Dr. David Basch & Dr. Alan Widlansky, Pllc Dba Dna Medical Center | General Practice | 486 W Huron St, Pontiac, MI 48341-1602 | 2013-07-09 |
| 1861765695 | Us Healthcare Mi, PC | General Practice | 461 W Huron St Ste 600, Pontiac, MI 48341-1601 | 2012-02-09 |
| 1245546415 | Express Health PC | General Practice | 461 W Huron St Ste 605, Pontiac, MI 48341-1601 | 2010-08-26 |
| 1851619464 | Rtc Enterprise, Inc. | General Practice | 1425 Giddings Rd, Pontiac, MI 48340-2111 | 2010-05-06 |
| 1861409302 | Bryan K Swilley | General Practice | 673 Mlk Blvd N, Pontiac, MI 48342 | 2006-08-01 |
| 1699114926 | Samer Sami Kannab Aida | General Practice | 50 N Perry St, Pontiac, MI 48342-2217 | 2013-06-19 |
| 1922265982 | Adnan Matta Md PC | General Practice | 44555 Woodward, #106, Pontiac, MI 48341 | 2008-05-19 |
| 1598951931 | Community Bridges Management, Inc. | General Practice | 31 Oakland Ave, 1st Floor, Suite E, Pontiac, MI 48342-2019 | 2007-09-19 |
| 1255484119 | Pontiac General Hospital and Medical Centers | General Practice | 461 W Huron St, Pontiac, MI 48341-1601 | 2007-01-22 |
| Find all providers in PONTIAC | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.