Southeast Michigan Medical Group, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101010072 Issued in MI

Legal business name

SOUTHEAST MICHIGAN MEDICAL GROUP, PC

Practice address

16018 S Huron River Dr
Romulus, MI 48174-3619

Phone

(419) 343-8537

Fax

(419) 893-3226

NPI assigned

Jul 13, 2009

Organization subpart

No

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

Authorized official

Name

Glenn Vance Dregansky, D.O.

Title

President

Phone

(419) 343-8537

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1952530883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16018 S HURON RIVER DR",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743619",
            "telephone_number": "419-343-8537",
            "fax_number": "419-893-3226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16018 S HURON RIVER DR",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743619",
            "telephone_number": "419-343-8537",
            "fax_number": "419-893-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MICHIGAN MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "DREGANSKY",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "VANCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-343-8537",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos Sims
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• Antoinette Smith
• Kelly Rae Smith, LMSW
• Southeast Michigan Physicians Group
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• Special Tree Neuro Care Center
• Special Tree Neuro Care Center

• Family Medicine Physician in Romulus, MI
• Providers in Romulus, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.