Park Place Family Practice & Internal Medicine
Organization Active NPI Internal Medicine Physician · Taylor, MI
NPI 1891307443 · NPPES record last updated Jul 21, 2021
Key facts
- NPI
- 1891307443
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- PARK PLACE FAMILY PRACTICE & INTERNAL MEDICINE
- Practice address
- 12701 Telegraph Rd Ste 103
Taylor, MI 48180-4087 - Phone
- (734) 374-0500
- Fax
- (734) 374-2415
- NPI assigned
- Aug 17, 2020
- Organization subpart
- No
Authorized official
- Name
- Susan Goswami
- Title
- Office Admin
- Phone
- (734) 374-0500
Practitioners 6
-
Raj A Goswami, M.D.
-
Achraf Slim, M.D
-
Mireille Touma, NURSE PRACTITIONER
-
Ramsewak Goswami, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200910000692 | MI | Part B Supplier - Clinic/Group Practice | 4880012657 |
Receives reassigned benefits from 6 practitioners Practice locations: Taylor, MI |
National Provider Directory
Locations
12701 Telegraph Rd
Ste 103
Taylor, MI 48180
Phone (734) 374-0500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
12701 Telegraph Rd Ste 103
Taylor, MI 48180-4087
Mailing address
12701 Telegraph Rd Ste 103
Taylor, MI 48180-4087
Phone (734) 374-0500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OH62264 | Other | MI | BCBSM PIN |
| 1891307443 | Medicaid | MI |
Other providers in Taylor, MI
- Par Wick Pharmacy LLC
- Paramount Performance (Hatch Doula Service)
- Pardee Foot Clinic
- Park Behavioral Health
- Park Nursing Center of Taylor, LLC
- Lawsen Parker
- John Tyler Parmer
- Kristy Parol
- Clifford L Partin
- Pas - Personal Accounting Services, Incorporated
All providers in Taylor, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.