Healthcare Provider Details

I. General information

NPI: 1538081690
Provider Name (Legal Business Name): GROVE HEALTH DIRECT PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W SHIAWASSEE AVE STE 104
FENTON MI
48430-2093
US

IV. Provider business mailing address

202 W SHIAWASSEE AVE STE 104
FENTON MI
48430-2093
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-0473
  • Fax:
Mailing address:
  • Phone: 248-266-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM MCCORMICK
Title or Position: OPERATIONS & COMMUNICATIONS
Credential:
Phone: 248-266-0473