Healthcare Provider Details

I. General information

NPI: 1578568036
Provider Name (Legal Business Name): PROFESSIONAL EMERGENCY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD EMERGENCY MEDICINE DEPARTMENT
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

38935 ANN ARBOR RD
LIVONIA MI
48150-3354
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-8780
  • Fax: 888-861-8740
Mailing address:
  • Phone: 734-632-0175
  • Fax: 888-861-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: JOHN BAUER
Title or Position: CMO
Credential: MD
Phone: 734-632-0175