OrganizationActive
Executive Diagnostic Group, PLLC
NPI 1881955953 · Multi-Specialty Clinic/Center · Dearborn, MI
Provider details
- NPI number
- 1881955953
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Luis Jorge, Owner(313) 359-9361
- License
- 4301038699 (MI)
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
1711 Monroe St
Dearborn, MI 48124-2914
Phone: (313) 359-9361
Fax: (313) 436-1767
Approximate (ZIP-level) locationGet directions
Mailing address
1711 Monroe St
Dearborn, MI 48124-2914
Registry dates
- Enumerated
- 2012-06-05
- Last updated
- 2014-09-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.