Healthcare Provider Details

I. General information

NPI: 1235219403
Provider Name (Legal Business Name): CRITICAL CARE MEDICINE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 208
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

3200 GREENFIELD RD SUITE 250
DEARBORN MI
48120-1802
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-5565
  • Fax: 313-271-1053
Mailing address:
  • Phone: 313-563-3332
  • Fax: 313-563-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY A COLEMAN
Title or Position: CEO, PHYSICIANLINX LLC
Credential:
Phone: 313-563-3332