Healthcare Provider Details

I. General information

NPI: 1861159600
Provider Name (Legal Business Name): NOVUS PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 COOLIDGE HWY
BERKLEY MI
48072-1633
US

IV. Provider business mailing address

3707 LINWOOD AVE
ROYAL OAK MI
48073-2355
US

V. Phone/Fax

Practice location:
  • Phone: 248-514-3397
  • Fax:
Mailing address:
  • Phone: 248-514-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA LEE PIERRET
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 248-514-3397