Provider Demographics
NPI:1679751564
Name:HOOVER MEDICAL CLINIC PC
Entity type:Organization
Organization Name:HOOVER MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-939-5830
Mailing Address - Street 1:31690 HOOVER
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-939-5830
Mailing Address - Fax:586-939-6914
Practice Address - Street 1:31690 HOOVER
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-939-5830
Practice Address - Fax:586-939-6914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOOVER MEDICAL CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK032018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3509949Medicare PIN
MIB46698Medicare UPIN