Healthcare Provider Details

I. General information

NPI: 1437120185
Provider Name (Legal Business Name): CRITICAL CARE MEDICINE PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S DENWOOD ST
DEARBORN MI
48124
US

IV. Provider business mailing address

DEPT 259301 P O BOX 67000
DETROIT MI
48267-2593
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4150
  • Fax: 313-791-2432
Mailing address:
  • Phone: 734-467-4150
  • Fax: 313-791-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number4301084496
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101020852
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301093939
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301094495
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301054803
License Number StateMI

VIII. Authorized Official

Name: JAMES T. LOVE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-467-4150