Healthcare Provider Details

I. General information

NPI: 1992086680
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY STE 202
CLARKSTON MI
48346-2087
US

IV. Provider business mailing address

6770 DIXIE HWY STE 202
CLARKSTON MI
48346-2087
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-0377
  • Fax: 248-620-0385
Mailing address:
  • Phone: 248-620-0377
  • Fax: 248-620-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTE007018
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberTE007018
License Number StateMI

VIII. Authorized Official

Name: DR. THEODORE G ENGELMANN
Title or Position: OWNER
Credential: DO
Phone: 24862003777