Lake Mi Mobile Doctors, P.C.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

LAKE MI MOBILE DOCTORS, P.C.

Doing business as

Mobile Doctors of Detroit

Practice address

24445 Northwestern Hwy
Suite #206
Southfield, MI 48075-6501

Phone

(248) 799-0086

Fax

(248) 350-1178

NPI assigned

Nov 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tysyn Contreras

Title

Director, Quality Assurance

Phone

(312) 939-5090

Specialties & licenses 1

Addresses

Other names 1

• Mobile Doctors of Detroit Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1700950607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 N ELSTON AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24445 NORTHWESTERN HWY",
            "address_2": "SUITE #206",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480756501",
            "telephone_number": "248-799-0086",
            "fax_number": "248-350-1178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR, QUALITY ASSURANCE",
        "authorized_official_telephone_number": "312-939-5090",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of Detroit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Geriatric Medicine (Internal Medicine) Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.