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

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1447610704

Provider Service Organization is a Geriatric Medicine (Family Medicine) Physician in Canton, Michigan. Registered with an NPI since 2016.

In the registry since
2016
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Practice location Address checks out

7233 Provincial Ct
Canton, MI 48187-2121
Phone: (734) 516-4239
Fax: (734) 404-5292
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X

Record details

NPI number1447610704
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ramon Villanueva — President · (734) 516-4239
NPI enumeratedFebruary 29, 2016
Last updated in NPPESJune 6, 2016
Mailing address7233 Provincial Ct, Canton, MI 48187-2121

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