1487349510 NPI number — PATIENT CENTERED FAMILY MEDICINE & OMT

Table of content: (NPI 1487349510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487349510 NPI number — PATIENT CENTERED FAMILY MEDICINE & OMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT CENTERED FAMILY MEDICINE & OMT
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:
PATIENT CENTERED FAMILY MEDICINE & OMT, PLLC
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:
1487349510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55275 8 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48167-9158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-924-4884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9960 VILLAGE PLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-869-6500
Provider Business Practice Location Address Fax Number:
248-869-6509
Provider Enumeration Date:
04/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSONNING
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
RENEA
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
248-924-4884

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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