Provider Demographics
NPI:1447525431
Name:GENESIS PHYSICIANS GROUP,
Entity type:Organization
Organization Name:GENESIS PHYSICIANS GROUP,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:248-593-9780
Mailing Address - Street 1:PO BOX 2477
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2477
Mailing Address - Country:US
Mailing Address - Phone:248-270-7246
Mailing Address - Fax:866-380-2182
Practice Address - Street 1:29777 TELEGRAPH RD
Practice Address - Street 2:SUITE 2415
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1303
Practice Address - Country:US
Practice Address - Phone:248-419-2416
Practice Address - Fax:248-419-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty