Healthcare Provider Details

I. General information

NPI: 1184745556
Provider Name (Legal Business Name): PRIME CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W HURON ST
PONTIAC MI
48341-1601
US

IV. Provider business mailing address

580 SUNLIGHT DR
ROCHESTER HILLS MI
48309-1330
US

V. Phone/Fax

Practice location:
  • Phone: 248-857-7583
  • Fax: 248-857-7588
Mailing address:
  • Phone: 248-390-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: HIMABINDU CHANDRASEKHAR
Title or Position: OWNER
Credential: MD
Phone: 248-390-3113