Healthcare Provider Details

I. General information

NPI: 1376467209
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER OF MICHIGAN,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 WILLIAMS RD
NEWPORT MI
48166-9500
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9583
US

V. Phone/Fax

Practice location:
  • Phone: 734-289-5555
  • Fax:
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-850-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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