Provider Demographics
NPI:1154765311
Name:NETWORK MEDICAL & THERAPEUTIC SERVICES, P.C.
Entity type:Organization
Organization Name:NETWORK MEDICAL & THERAPEUTIC SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEON
Authorized Official - Middle Name:LAMARIO
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-968-2372
Mailing Address - Street 1:22000 GREENFIELD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2500
Mailing Address - Country:US
Mailing Address - Phone:248-968-2372
Mailing Address - Fax:248-968-2863
Practice Address - Street 1:22000 GREENFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2500
Practice Address - Country:US
Practice Address - Phone:248-968-2372
Practice Address - Fax:248-968-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066401261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301066401OtherLICENSE