Healthcare Provider Details

I. General information

NPI: 1548724784
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER OF MICHIGAN,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003 W ALBAIN RD RM 195
MONROE MI
48161-9558
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9583
US

V. Phone/Fax

Practice location:
  • Phone: 734-654-2169
  • Fax: 734-654-2535
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-847-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ED LARKINS
Title or Position: CEO
Credential:
Phone: 734-850-6914