Healthcare Provider Details

I. General information

NPI: 1609058627
Provider Name (Legal Business Name): FLUSHING FAMILY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6429 W PIERSON RD
FLUSHING MI
48433-2396
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-659-4400
  • Fax: 810-659-4467
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301044793
License Number StateMI

VIII. Authorized Official

Name: KIM HENDRICK
Title or Position: OWNER
Credential: MD
Phone: 810-659-4400