MEDICARE: PROFESSIONAL EMERGENCY CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MI
2	208000000X	Pediatrics Physician	MI
3	363A00000X	Physician Assistant	MI
4	363L00000X	Nurse Practitioner	MI
5	207P00000X	Emergency Medicine Physician	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CC0535	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700D410740	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	010Q262940	OTHER	MI	BCBSMI
4	700E014610	OTHER		BCBS

General Provider Information

NPI Number	:	1578568036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL EMERGENCY CARE, P.C.

Provider Business Mailing Address
First Line	:	38935 ANN ARBOR RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-3354
Country	:	US
Telephone Number	:	734-632-0175
Fax Number	:	888-861-8740

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	DEARBORN
State	:	MI
Zip	:	48124-4089
Country	:	US
Telephone Number	:	313-593-8780
Fax Number	:	888-861-8740

Authorized Official
Title or Position	:	CMO
Name	:	JOHN BAUER
Credential	:	MD
Telephone Number	:	734-632-0175

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/15/2014

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Directions to “PROFESSIONAL EMERGENCY CARE, P.C. ” Practice Location

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