Healthcare Provider Details

I. General information

NPI: 1528851607
Provider Name (Legal Business Name): COMPLEXCARE MEDICAL GROUP MIDWEST M PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 W 11 MILE RD STE 109
NOVI MI
48375-1818
US

IV. Provider business mailing address

41800 W 11 MILE RD STE 109
NOVI MI
48375-1818
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-1220
  • Fax: 248-218-9996
Mailing address:
  • Phone: 248-660-1220
  • Fax: 248-218-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: SVETLANA VINOKUR
Title or Position: CFO
Credential:
Phone: 847-275-9504