Provider Demographics
NPI:1386688992
Name:EPMG OF MICHIGAN, P.C.
Entity type:Organization
Organization Name:EPMG OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-807-9009
Mailing Address - Street 1:PO BOX 80310
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1310
Mailing Address - Country:US
Mailing Address - Phone:954-939-5000
Mailing Address - Fax:877-250-6889
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:954-939-5000
Practice Address - Fax:877-250-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H110610OtherBC/BS OF MICHIGAN
MI500H111170OtherBCBS OF MICHIGAN NP NO
MI0M60650Medicare ID - Type Unspecified
MI0N92530Medicare ID - Type Unspecified
MI0N92710Medicare ID - Type Unspecified
MI500H111170OtherBCBS OF MICHIGAN NP NO
MI0M60660Medicare ID - Type Unspecified
MI0N21940Medicare ID - Type Unspecified