Provider Demographics
NPI:1851798235
Name:EXPRESS PHYSICIANS LIMITED LIABILITY PARTNERSHIP
Entity type:Organization
Organization Name:EXPRESS PHYSICIANS LIMITED LIABILITY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-399-7258
Mailing Address - Street 1:17330 NORTHLAND PARK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4318
Mailing Address - Country:US
Mailing Address - Phone:313-399-7258
Mailing Address - Fax:248-552-8144
Practice Address - Street 1:17330 NORTHLAND PARK CT
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4318
Practice Address - Country:US
Practice Address - Phone:313-399-7258
Practice Address - Fax:248-552-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty