Healthcare Provider Details

I. General information

NPI: 1184677866
Provider Name (Legal Business Name): FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 FORT ST
RIVERVIEW MI
48193-6701
US

IV. Provider business mailing address

19020 FORT ST
RIVERVIEW MI
48193-6701
US

V. Phone/Fax

Practice location:
  • Phone: 734-362-5100
  • Fax: 734-362-5147
Mailing address:
  • Phone: 734-362-5100
  • Fax: 734-362-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE M LEROY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 734-362-5132