MMG 1PC (NPI# 1679586192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679586192 |
| Entity Type | Organization |
| Organization Name | MMG 1PC |
| Other Organization Name | PREMIER INTERNISTS |
| Practice Address |
29201 Telegraph Rd Suite 404 Southfield MI 48034-1331 |
| Mailing Address |
29992 Northwestern Hwy Ste C Farmington Hills MI 48334-3292 |
| Practice Telephone | 2483550880 |
| Practice Fax Number | 2483559232 |
| Mailing Telephone | 2488511430 |
| Mailing Fax Number | 2488515182 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2018-09-20 |
| Authorized Official Name | DR. GEOFFREY A TRIVAX (PRESIDENT) |
| Authorized Official Telephone | 2483549666 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE SHIELD GROUP | 700F314390 | 01 |
| Other Name | Type Code |
|---|---|
| PREMIER INTERNISTS | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215040506 | Mmg 1pc | Internal Medicine | 28625 Northwestern Hwy Ste 100, Southfield, MI 48034-8351 | 2006-08-17 |
| 1285873430 | Mmg 1pc | Physical Medicine & Rehabilitation | 28625 Northwestern Hwy, Suite 150, Southfield, MI 48034-1828 | 2009-02-11 |
| 1184878001 | Mmg 1pc | Psychiatry & Neurology | 26400 W 12 Mile Rd, Suite 170, Southfield, MI 48034-1700 | 2008-11-05 |
| 1215103940 | Mmg 1pc | General Practice | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2008-05-02 |
| 1972700607 | Mmg 1pc | Physical Therapist | 26400 W 12 Mile Rd, Suite 25, Southfield, MI 48034-1700 | 2007-06-27 |
| 1881714723 | Mmg 1pc | Internal Medicine | 28000 Joy Rd, Livonia, MI 48150-4137 | 2007-03-31 |
| 1629184049 | Mmg 1pc | Internal Medicine | 28625 Northwestern Hwy, Suite 223, Southfield, MI 48034-1828 | 2006-08-21 |
| 1023037025 | Mmg 1pc | Nurse Practitioner | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2006-07-19 |
| 1205855186 | Mmg 1pc | Internal Medicine | 7419 Middlebelt Rd, Suite 4, West Bloomfield, MI 48322-4182 | 2006-07-19 |
| 1073548442 | Mmg 1pc | Internal Medicine | 6900 Orchard Lake Rd, Suite 303, West Bloomfield, MI 48322-3405 | 2006-07-12 |
| Street Address |
29201 TELEGRAPH RD SUITE 404 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48034-1331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073504122 | David G Heidemann | Ophthalmology | 29201 Telegraph Rd, Suite 101, Southfield, MI 48034-1331 | 2005-10-28 |
| 1689184202 | Jihan Elise El-kurdi | Physical Therapy Assistant | 29201 Telegraph Rd, Southfield, MI 48034-1331 | 2017-10-10 |
| 1417400581 | Maggie Leonards | Audiologist | 29201 Telegraph Rd, Suite 500, Southfield, MI 48034-1331 | 2016-07-25 |
| 1174963045 | Abraham Isaias Gomez Hernandez | Student in an Organized Health Care Education/Training Program | 29201 Telegraph Rd, Ste 324, Southfield, MI 48034-1331 | 2013-06-25 |
| 1265794739 | Michfoot Surgeons, P.C. | Podiatrist | 29201 Telegraph Rd, Suite 100, Southfield, MI 48034-1331 | 2012-06-11 |
| 1528333051 | Amy H. Rogers | Speech-Language Pathologist | 29201 Telegraph Rd, Suite 500, Southfield, MI 48034-1331 | 2012-03-16 |
| 1164756276 | Harry Hunter Jr. | Social Worker | 29201 Telegraph Rd, 550, Southfield, MI 48034-1331 | 2009-09-22 |
| 1013147586 | Chirag Gupta | Optometrist | 29201 Telegraph Rd, Suite # 101, Southfield, MI 48034-1331 | 2009-07-20 |
| 1811127376 | Elliott Michael Wolf | Psychiatry & Neurology | 29201 Telegraph Rd, Suite 600, Southfield, MI 48034-1331 | 2009-07-19 |
| 1306075551 | Phoenix Medical Group, P.C. | Internal Medicine | 29201 Telegraph Rd, 450, Southfield, MI 48034-1331 | 2009-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780219196 | I. R. Horn & Associates LLC | Community/Behavioral Health | 29623 Norhtwestern Hwy Suite 5, Southfield, MI 48034 | 2020-03-05 |
| 1003378753 | Alexis Shivers | Physical Therapy Assistant | 27500 Lahser Rd, Southfield, MI 48034 | 2019-04-02 |
| 1598257768 | El-abbadi Pediatric Clinic | Pediatrics | 24676 Lahser Road, Southfield, MI 48034 | 2018-06-04 |
| 1689166894 | Recore Rehabilitation Services | Clinic/Center | 25899 W 12 Mile Rd # 340, Southfield, MI 48034 | 2018-06-04 |
| 1578063749 | El-abbadi Healthcare Center | Clinic/Center | 27403 Lahser Rd, Southfield, MI 48034 | 2018-02-14 |
| 1063924819 | Diagnostic Hematology, PC | Clinical Medical Laboratory | 24725 W. Twelve Mile Road, Suite 118, Southfield, MI 48034 | 2017-11-02 |
| 1962929125 | Toms Holistic Home Visits Pllc | Clinic/Center | 28675 Franklin Rd, Suite 217, Southfield, MI 48034 | 2017-08-28 |
| 1265956940 | Abbadi Healthcare | Pharmacy | 27402 Lahser Road, Southfield, MI 48034 | 2017-08-03 |
| 1720517113 | Theramedic Home Health Care LLC | Home Health | 26400 W. 12 Mile Rd, Suite 80, Southfield, MI 48034 | 2017-06-08 |
| 1538695804 | Adrienne Rutherford | Occupational Therapist | 25999 Franklin Pointe Dr, Southfield, MI 48034 | 2017-05-05 |
| Find all providers in zip 48034 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053910687 | Berry Johnson Health Pllc | Internal Medicine | 30123 Rock Creek Dr, Southfield, MI 48076-5358 | 2020-10-24 |
| 1063036960 | Hawra Kamal | Internal Medicine | Academic Internal Medicine 22250 Providence Dr, 3pmb Suite #301, Southfield, MI 48075-4818 | 2020-06-05 |
| 1578187175 | Brittni Mcclellan | Internal Medicine | 16001 W 9 Mile Rd # Rs, Southfield, MI 48075-4818 | 2020-05-31 |
| 1841811882 | Humza Medical Md PC | Internal Medicine | 27207 Lahser Suite 200b, Southfield, MI 48034-8407 | 2020-04-30 |
| 1487168001 | Us Knee Center Pllc | Internal Medicine | 24901 Northwestern Hwy Ste 113, Southfield, MI 48075-2200 | 2017-11-17 |
| 1427576636 | Comfort Care Center Corp | Internal Medicine | 15565 Northland Dr E Ste 204, Southfield, MI 48075 | 2017-09-07 |
| 1609391382 | Excellence Home Physicians | Internal Medicine | 16910 W 10 Mile Rd Ste 105, Southfield, MI 48075-2900 | 2017-08-03 |
| 1598112567 | Ark Multispecialty Physicians Pllc | Internal Medicine | 25130 Southfield Rd, Suite 230, Southfield, MI 48075-1910 | 2016-05-19 |
| 1659756005 | Haseeb Aslam | Internal Medicine | 16001 West Nile Mile Road Fisher Center, 401, Southfield, MI 48075 | 2015-07-28 |
| 1548643562 | Erin Goldman | Internal Medicine | 16001 W Nine Mile Road, Providence Hospital Medical Ctr. Grad Med Education, Southfield, MI 48075 | 2015-07-08 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48034 |
Please comment or provide details below to improve the information on MMG 1PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.