Healthcare Provider Details

I. General information

NPI: 1467076273
Provider Name (Legal Business Name): COMPLEX CARE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23767 MAUDE LEA ST
NOVI MI
48375-3540
US

IV. Provider business mailing address

PO BOX 654
NORTHVILLE MI
48167-0654
US

V. Phone/Fax

Practice location:
  • Phone: 248-787-1862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMARA ANN FORD
Title or Position: MANAGING PARTNER
Credential:
Phone: 248-787-1862