Provider Demographics
NPI:1427126655
Name:GREEN CROSS MEDICAL CENTER PC
Entity type:Organization
Organization Name:GREEN CROSS MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:GUECO
Authorized Official - Last Name:QUIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-837-0072
Mailing Address - Street 1:18041 GREENFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-837-0072
Mailing Address - Fax:313-837-0003
Practice Address - Street 1:18041 GREENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-837-0072
Practice Address - Fax:313-837-0003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN CROSS MEDICAL CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H211540OtherBLUE CROSS
MI700H211540OtherBLUE CROSS