1174696009 NPI number — PREFERRED HEALTH MANAGEMENT CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174696009 NPI number — PREFERRED HEALTH MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HEALTH MANAGEMENT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREFERRED FAMILY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174696009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37300 DEQUINDRE RD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48310-3591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-825-2313
Provider Business Mailing Address Fax Number:
586-825-2317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37300 DEQUINDRE RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48310-3591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-825-2313
Provider Business Practice Location Address Fax Number:
586-825-2317
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IGWE
Authorized Official First Name:
NDUBISI
Authorized Official Middle Name:
GRANT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
586-825-2310

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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