Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Executive Diagnostic Group, PLLC

Organization Multi-Specialty Clinic/Center · NPI 1881955953

Executive Diagnostic Group, PLLC is a Multi-Specialty Clinic/Center in Dearborn, Michigan. Licensed in Michigan. Registered with an NPI since 2012.

Licensed in
MI
In the registry since
2012
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1711 Monroe St
Dearborn, MI 48124-2914
Phone: (313) 359-9361
Fax: (313) 436-1767
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Multi-Specialty Clinic/Center (primary) Taxonomy 261QM1300X · Licence 4301038699 (MI)

Record details

NPI number1881955953
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Luis Jorge — Owner · (313) 359-9361
NPI enumeratedJune 5, 2012
Last updated in NPPESSeptember 18, 2014
Mailing address1711 Monroe St, Dearborn, MI 48124-2914

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