Provider Demographics
NPI:1790651495
Name:PHASE MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:PHASE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CHRISTOFIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-847-0626
Mailing Address - Street 1:6905 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1282
Mailing Address - Country:US
Mailing Address - Phone:248-847-0626
Mailing Address - Fax:248-847-0726
Practice Address - Street 1:6905 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1282
Practice Address - Country:US
Practice Address - Phone:248-847-0626
Practice Address - Fax:248-847-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-11
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty