Provider Demographics
NPI:1447263207
Name:MCAULEY MCPHERSON MEDICAL OFFICES
Entity type:Organization
Organization Name:MCAULEY MCPHERSON MEDICAL OFFICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHYSICAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMBOURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-712-7358
Mailing Address - Street 1:620 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1002
Practice Address - Country:US
Practice Address - Phone:734-712-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty