Healthcare Provider Details

I. General information

NPI: 1346690245
Provider Name (Legal Business Name): GOLDEN FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23463 E SCOTT BLVD
CLINTON TOWNSHIP MI
48036-3155
US

IV. Provider business mailing address

23463 E SCOTT BLVD
CLINTON TOWNSHIP MI
48036-3155
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-0482
  • Fax:
Mailing address:
  • Phone: 734-945-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number510108586
License Number StateMI

VIII. Authorized Official

Name: DR. BRANDI NICOLE BASKET
Title or Position: OWNER
Credential: DO
Phone: 734-945-0482