Provider Demographics
NPI:1588078943
Name:MAGNUM MANAGEMENT INC.
Entity type:Organization
Organization Name:MAGNUM MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-424-9749
Mailing Address - Street 1:17600 WEST EIGHT MILE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4316
Mailing Address - Country:US
Mailing Address - Phone:248-424-9749
Mailing Address - Fax:
Practice Address - Street 1:17600 W 8 MILE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4305
Practice Address - Country:US
Practice Address - Phone:248-424-9749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007121302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N78250Medicare UPIN