1699370858 NPI number — FAMILY MEDICAL CENTER OF MICHIGAN,INC

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 1699370858 NPI number — FAMILY MEDICAL CENTER OF MICHIGAN,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MEDICAL CENTER OF MICHIGAN,INC
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:
1699370858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8765 LEWIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPERANCE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48182-9300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-850-6903
Provider Business Mailing Address Fax Number:
734-850-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 NEWPORT S. RD
Provider Second Line Business Practice Location Address:
SPEECH ROOM
Provider Business Practice Location Address City Name:
CARLETON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-654-2169
Provider Business Practice Location Address Fax Number:
734-654-2535
Provider Enumeration Date:
12/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LARKINS
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
734-850-6914

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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