Healthcare Provider Details

I. General information

NPI: 1437161437
Provider Name (Legal Business Name): PARK FAMILY HEALTH CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12871 E JEFFERSON AVE
DETROIT MI
48215-2754
US

IV. Provider business mailing address

28212 FRANKLIN RD
SOUTHFIELD MI
48034-1659
US

V. Phone/Fax

Practice location:
  • Phone: 313-821-3900
  • Fax: 313-821-1511
Mailing address:
  • Phone: 248-356-5555
  • Fax: 248-356-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY HOWARD BROWN
Title or Position: CEO
Credential:
Phone: 248-356-5555