Provider Demographics
NPI:1174696009
Name:PREFERRED HEALTH MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:PREFERRED HEALTH MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NDUBISI
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-825-2310
Mailing Address - Street 1:37300 DEQUINDRE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3591
Mailing Address - Country:US
Mailing Address - Phone:586-825-2313
Mailing Address - Fax:586-825-2317
Practice Address - Street 1:37300 DEQUINDRE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3591
Practice Address - Country:US
Practice Address - Phone:586-825-2313
Practice Address - Fax:586-825-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P06570Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER