Provider Demographics
NPI:1265543318
Name:OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY ASSOCIATE PHYSICIANS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TELESFORO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-9207
Mailing Address - Street 1:2725 WARNER DR
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2445
Mailing Address - Country:US
Mailing Address - Phone:248-360-7797
Mailing Address - Fax:
Practice Address - Street 1:2520 S TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0285
Practice Address - Country:US
Practice Address - Phone:248-335-9207
Practice Address - Fax:248-335-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430103648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4520161Medicaid
MI10-4170054Medicaid
MI10-4609965Medicaid
MI104170036Medicaid
MI10-4170027Medicaid
MI10-4170054Medicaid
MI10-4520161Medicaid
MII01887Medicare UPIN
MIB46484Medicare UPIN
MI10-4170027Medicaid
MIA76981Medicare UPIN
MIH69796Medicare UPIN
MI10-4609965Medicaid
MI104170036Medicaid
MIN80090005Medicare ID - Type Unspecified