Healthcare Provider Details

I. General information

NPI: 1922397447
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER OF MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N MACOMB ST STE 3
MONROE MI
48162-3076
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9583
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-4851
  • Fax: 734-240-4853
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-850-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ED LARKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 734-850-6914