1215131040 NPI number — PRIMARY PHYSICIANS UNLIMITED PLLC

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 1215131040 NPI number — PRIMARY PHYSICIANS UNLIMITED PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY PHYSICIANS UNLIMITED PLLC
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:
Provider Other Organization Name Type Code:
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:
1215131040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-0606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17422 W 10 MILE RD
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-443-7245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAIRSTON
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR AND OWNER
Authorized Official Telephone Number:
313-570-3521

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4265873 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com