Healthcare Provider Details

I. General information

NPI: 1588199772
Provider Name (Legal Business Name): FAMILY MEDICINE CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24336 MICHIGAN AVE
DEARBORN MI
48124-1828
US

IV. Provider business mailing address

30700 TELEGRAPH RD SUITE 1645
BINGHAM FARMS MI
48025-4524
US

V. Phone/Fax

Practice location:
  • Phone: 248-283-1100
  • Fax: 248-283-1103
Mailing address:
  • Phone: 248-283-1100
  • Fax: 248-283-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: JUNAED UL HAQ
Title or Position: PARTNER
Credential: MD
Phone: 248-283-1100