Healthcare Provider Details

I. General information

NPI: 1477288348
Provider Name (Legal Business Name): CARECONNECTMD MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

IV. Provider business mailing address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax: 562-803-4500
Mailing address:
  • Phone: 888-789-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ORLANDO COLLADO
Title or Position: OWNER
Credential: MD
Phone: 888-789-9585