Healthcare Provider Details

I. General information

NPI: 1376718833
Provider Name (Legal Business Name): MONROE AFTER HOURS PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 N MONROE ST
MONROE MI
48162-5360
US

IV. Provider business mailing address

1397 N MONROE ST
MONROE MI
48162-5360
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-3420
  • Fax:
Mailing address:
  • Phone: 734-243-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KYMM PIETSZAK
Title or Position: MANAGER
Credential:
Phone: 734-243-3420