Healthcare Provider Details

I. General information

NPI: 1982826467
Provider Name (Legal Business Name): CHILDRENS AND FAMILY MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 ALLEN RD
ALLEN PARK MI
48101-1401
US

IV. Provider business mailing address

8542 N CANTON CENTER RD
CANTON MI
48187-1310
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-1500
  • Fax: 313-386-1503
Mailing address:
  • Phone: 800-827-3797
  • Fax: 248-553-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PREM DUA
Title or Position: PRESIDENT
Credential: MD
Phone: 313-386-1500