Provider Demographics
NPI:1194494484
Name:PLATINUM MANAGEMENT LLC
Entity type:Organization
Organization Name:PLATINUM MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-359-8300
Mailing Address - Street 1:5250 AUTO CLUB DR STE 170
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2619
Mailing Address - Country:US
Mailing Address - Phone:313-359-8300
Mailing Address - Fax:313-359-8305
Practice Address - Street 1:5250 AUTO CLUB DR STE 170
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2619
Practice Address - Country:US
Practice Address - Phone:313-335-9800
Practice Address - Fax:313-359-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty