Healthcare Provider Details

I. General information

NPI: 1487349510
Provider Name (Legal Business Name): PATIENT CENTERED FAMILY MEDICINE & OMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 VILLAGE PLACE BLVD
BRIGHTON MI
48116-2089
US

IV. Provider business mailing address

55275 8 MILE RD
NORTHVILLE MI
48167-9158
US

V. Phone/Fax

Practice location:
  • Phone: 248-869-6500
  • Fax: 248-869-6509
Mailing address:
  • Phone: 248-924-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA RENEA ANDERSONNING
Title or Position: SOLE OWNER
Credential: DO
Phone: 248-924-4884