Organization Name: | RICHARD C MERTZ JR MD PC |
NPI Number: | 1043395502 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES W KLEIN (MEDICAL DIRECTOR) |
Mailing Address: | 21711 Greater Mack Ave Saint Clair Shores |
State: | MI US |
Postal Code: | 480802418 |
Phone Number: | 5867740393 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 06/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |