Healthcare Provider Details

I. General information

NPI: 1336185347
Provider Name (Legal Business Name): LIFETIME FAMILY CARE, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31022 UTICA RD
FRASER MI
48026-2534
US

IV. Provider business mailing address

31022 UTICA RD
FRASER MI
48026-2534
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-1340
  • Fax: 586-293-7079
Mailing address:
  • Phone: 586-293-1340
  • Fax: 586-293-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015717
License Number StateMI

VIII. Authorized Official

Name: DR. IA YANG KUE
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 586-293-1340