Healthcare Provider Details

I. General information

NPI: 1376794214
Provider Name (Legal Business Name): P-COR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 12/10/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22500 HAGGERTY RD
FARMINGTON HILLS MI
48335-2809
US

IV. Provider business mailing address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

V. Phone/Fax

Practice location:
  • Phone: 248-477-9300
  • Fax: 248-477-5808
Mailing address:
  • Phone: 248-588-9300
  • Fax: 248-588-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002296
License Number StateMI

VIII. Authorized Official

Name: GAIL ELIAS
Title or Position: VICE PRESIDENT
Credential:
Phone: 248-577-3624