Healthcare Provider Details

I. General information

NPI: 1114149317
Provider Name (Legal Business Name): MILFORD FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 N MILFORD RD
MILFORD MI
48381-1018
US

IV. Provider business mailing address

1265 N MILFORD RD
MILFORD MI
48381-1018
US

V. Phone/Fax

Practice location:
  • Phone: 248-685-3600
  • Fax: 248-685-0368
Mailing address:
  • Phone: 248-685-3600
  • Fax: 248-685-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLLEEN M CAMPO
Title or Position: PRACTICE ADMINSTRATOR
Credential:
Phone: 248-685-3600